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.
However, for a while, adopting and investing in telehealth services had been too high, and the distribution of telehealth resolutions and hospital-based networks proved to be too costly. But now, due to technological improvement, improved broadband services are now powerful and easily affordable which makes the level of return on investment in telehealth higher than ever before. Across almost all medical specialties, telehealth services can be applied in connecting providers with different patients in different locations via real-time audio and video. In other cases, service centers can use telemedicine to collect remotely as well as send data to a central monitoring system for interpretation.
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).
Teledermatology allows dermatology consultations over a distance using audio, visual and data communication, and has been found to improve efficiency.[70] Applications comprise health care management such as diagnoses, consultation and treatment as well as (continuing medical) education.[71][72][73] The dermatologists Perednia and Brown were the first to coin the term "teledermatology" in 1995. In a scientific publication, they described the value of a teledermatologic service in a rural area underserved by dermatologists.[74]
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. 
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.

Referring to health information services, health care education, and health care services in a broad sense, the term telehealth is an all-encompassing one. In fact, telecare and telemedicine are generally covered within the broader scope of the term telehealth. Included in telehealth are health education services, remote monitoring of vital signs, ECG or blood pressure and remote doctor-patient consultations (telemedicine). Telehealth technology enables the remote diagnoses and evaluation of patients in addition to the ability to remote detection of fluctuations in the medical condition of the patient at home so that the medications or the specific therapy can be altered accordingly. It also allows for e-prescribe medications and remotely prescribed treatments.
As a caregiver for a loved one, you have enough to worry about. That’s why Teladoc® gives you a convenient and affordable way to provide care, letting you arrange a 2- or 3-way video or phone visit with a licensed doctor 24/7 for just $45/visit. Add the individual you care for to your Teladoc® account, even if they’re not covered by your health plan.
Currently, smokers can seek help in the form of one on one therapy, group counselling sessions, or through medicated means, such as a patch or gum. There are also prescription medications which have shown increasing success across the United States. The most popular of these are Wellbutrin, Zyban, and Chantix. To learn more about these prescriptions and to obtain your own today,click here.
^ Cartwright M, Hirani SP, Rixon L, Beynon M, Doll H, Bower P, et al. (February 2013). "Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial". BMJ (Clinical Research Ed.). 346: f653. doi:10.1136/bmj.f653. PMC 3582704. PMID 23444424.
Teladoc Health enjoys a killer advantage with its head start in telehealth. Around 40% of the largest companies in the world contract with Teladoc to provide virtual healthcare services to their employees. Over 35 of the biggest health plans in the U.S. have partnered with Teladoc. More than 290 hospitals and health systems have teamed up with the telehealth leader.
Jay McGraw and Adam Jackson, both 35, are changing the way that people interact with their doctors. Along with Dr. Phil, who is McGraw’s father, they launched Doctor On Demand in 2013. The San-Francisco-based startup offers online video consultations with 1,400 credentialed physicians around the country. One million people have downloaded the app -- and it’s raised $74 million in VC funding to date.
But getting doctors to jump on board is easier said than done, and takes time. Many are afraid of liability, as it's possible to miss something during a remote visit. And for years, it wasn't clear whether they would get paid as much as an in-person visit. Reimbursement questions are still getting resolved across different states, but most of the commercial and government plans are on board with the idea of telemedicine -- at least in specific circumstances.
Kelly had the chance to test out the Doctor on Demand app, and it took her about ten minutes after downloading the app to start video chatting with a cool doc on her smartphone. Kelly’s session took about five minute total, and as soon as it was done, the doctor sent an antibiotic prescription straight to the pharmacy for her. 20 minutes later, she got a text saying it was ready to be picked up, and in under an hour, she had her prescription from Walgreens. For those who prioritize speed and low hassle over familiarity of their own doctor (or health center), or even those without insurance, this is a real win.

These devices can be packed into a kit and sent out into the field. In this way, telemedicine has proved extremely useful in rural and developing countries like Gabon, Iraqi Kurdistan, and Nigeria, where there is very little access to high-quality medical care. Telemedicine eliminates the barrier of distance and improves access to medical services that would otherwise not be available in distant rural communities.   


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.
Teladoc, founded in 2002, was initially slow to catch on. But after it grew revenues by 100% in 2013 and with sales set to double again this year, investors have come running: The company just closed a $50 million Series F fundraising round, bringing its total funding to roughly $100 million, according to CEO Jason Gorevic, who joined the company in 2009. (Gorevic even had to turn away investors as the recent funding round was oversubscribed, he says.)
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.

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.
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Doctor On Demand is one of the best-funded Bay Area digital health companies. The region's top digital health startups pulled in $1.5 billion in 2016. As health care continues finding customers outside hospital walls, the industry has seen even brick-and-mortar providers investing in the tech. Fifty million Americans are now willing to switch doctors if given a video visit option, according to a recent trends report.
Despite the current reimbursement challenges, there are numerous benefits to increasing the use of telehealth to meet the nation’s demand for health care. Convenience of care, increased access, improved worker productivity from not having to take time off and travel to appointments, decreased costs, and clinician time savings are a few. For these reasons, providers, payers, and employers alike are moving forward with more and more telehealth solutions.
Since the internet and mobile devices now pervade our lives, it is natural that people want to leverage telehealth technologies to improve care, offer convenience, promote access, and support sustainability. Telehealth services range from consultations and video conference mental health sessions to public health broadcast text messaging and on-demand provider education.
Without proper medication, asthma and other respiratory related illnesses can be extremely serious. Chronic asthma affects more than 20-million citizens across the United States, and can appear in early childhood or adolescence. The symptoms vary from person to person, with most individuals experiencing shortness of breath, tightening of the chest, coughing, and wheezing.
All the doctors in Teladoc's national network are U.S. board-certified family practitioners, primary care physicians, pediatricians and internists who use Electronic Health Records to diagnose, treat and write prescriptions when necessary. When accessing Teladoc, you'll be connected to a doctor in your state. These doctors are all actively practicing physicians and choose to incorporate telemedicine into their medical practice as a way to offer more affordable, convenient access to quality care.
“In addition, clinical outcomes should be defined and data capture and review capabilities should be implemented to ensure clinical standards of care are followed, to evaluate clinical outcomes and patient and provider satisfaction, and to continually look for opportunities to improve the virtual process,” Sokolovich said. “In addition, having a dedicated IT support system in place for telehealth providers across the system is key to long-term success and removes the concern for equipment failure and connectivity issues that may result in virtual visit challenges.”
The Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services defines telehealth as the use of electronic information and telecommunications technologies to support and promote 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.
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.
The population of the United States is growing, aging, and becoming more prone to chronic conditions like diabetes, congestive heart failure, and COPD. This is creating a perfect storm of demand on the healthcare system, yet there is a shortage in the pipeline of healthcare providers being educated, trained, and licensed to practice. This necessitates getting very smart about how healthcare resources are leveraged to provide high-quality care to the highest number of people possible.  Telehealth technologies increase the efficiency of the healthcare system overall by maximizing the productivity of each provider and removing geographical barriers to care.
Store and forward, a type of telemedicine that allows providers to share information over a distance, has been a game changer. Today, primary care physicians can connect with specialists who are in another location than them. Healthcare information like diagnostic images, blood analysis, and more can be shared for appropriate patient assessment in real time.

Today the telemedicine field is changing faster than ever before. As technology advances at exponential levels, so does the widespread affordability and accessibility to basic telemedicine tools. For example, not only do we now have the technology for live video telemedicine, but much of the U.S. population has experience using online videochat apps (like Skype or Facetime), and access to a computer or mobile device to use them.
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.
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.
Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology. Today, applications of teleophthalmology encompass access to eye specialists for patients in remote areas, ophthalmic disease screening, diagnosis and monitoring; as well as distant learning. Teleophthalmology may help reduce disparities by providing remote, low-cost screening tests such as diabetic retinopathy screening to low-income and uninsured patients.[75][76] In Mizoram, India, a hilly area with poor roads, between 2011 till 2015, Tele-ophthalmology has provided care to over 10000 patients. These patients were examined by ophthalmic assistants locally but surgery was done on appointment after viewing the patient images online by Eye Surgeons in the hospital 6–12 hours away. Instead of an average 5 trips for say, a cataract procedure, only one was required for surgery alone as even post op care like stitch removal and glasses was done locally. There were huge cost savings in travel etc.[77]
The technological advancement of wireless communication devices is a major development in telehealth.[19] This allows patients to self-monitor their health conditions and to not rely as much on health care professionals. Furthermore, patients are more willing to stay on their treatment plans as they are more invested and included in the process, decision-making is shared.[20][21] Technological advancement also means that health care professionals are able to use better technologies to treat patients for example in surgery. Technological developments in telehealth are essential to improve health care, especially the delivery of healthcare services, as resources are finite along with an ageing population that is living longer.[19][20][21]
Interoperability: This refers to two systems ((software, networks, communication devices, computers and other types of information technology components))or more being able to interact with each other and exchange information so that predictable results can be achieved. There are three different kinds of interoperability: technical; clinical and human/operational.
The telemedicine foundation is quickly being built. But what do patients think about telemedicine? Are they ready to try it? Recent studies show that a majority of patients are interested in using telehealth services, especially once they see how it works and the potential benefits for them. NTT Data found 74% of surveyed US patients were open to using telemedicine services, and were comfortable communicating with their doctors via technology. 67% said telemedicine at least somewhat increases their satisfaction with medical care.
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.
For developing countries, telemedicine and eHealth can be the only means of healthcare provision in remote areas. For example, the difficult financial situation in many African states and lack of trained health professionals has meant that the majority of the people in sub-Saharan Africa are badly disadvantaged in medical care, and in remote areas with low population density, direct healthcare provision is often very poor[90] However, provision of telemedicine and eHealth from urban centres or from other countries is hampered by the lack of communications infrastructure, with no landline phone or broadband internet connection, little or no mobile connectivity, and often not even a reliable electricity supply.[91]
“In addition, clinical outcomes should be defined and data capture and review capabilities should be implemented to ensure clinical standards of care are followed, to evaluate clinical outcomes and patient and provider satisfaction, and to continually look for opportunities to improve the virtual process,” Sokolovich said. “In addition, having a dedicated IT support system in place for telehealth providers across the system is key to long-term success and removes the concern for equipment failure and connectivity issues that may result in virtual visit challenges.”
* Physicians on Silver Cross Hospital’s Medical Staff have expertise in their areas of practice to meet the needs of patients seeking their care.  These physicians are independent practitioners on the Medical Staff and are not the agents or employees of Silver Cross Hospital. They treat patients based upon their independent medical judgment and they bill patients separately for their services. 
Yet healthcare systems struggle to turn this form of technology into a profitable revenue stream. Consumers have been slow to adopt this model. And, according to a Rand study published in 2017, it appears to attract a new set of consumers who might not otherwise use medical services, thereby driving costs up. Findings related to utilization and spending for acute respiratory illness based on commercial claims data from more than 300,000 patients between 2011 and 2013 included:

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."
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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