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.
Distance Learning: The use of audio and video technologies allows students to attend training sessions classes that are conducted from a remote location. Usually distance learning systems are interactive. They are a useful tool for delivering education and training to students that are widely dispersed, or in some cases where an instructor is unable to travel to the site where the students are located.
One especially successful telemedicine project funded by the government was called the Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC), and was a partnership between NASA and the Indian Health Services. The program funded remote medical services to Native Americans living on the Papago Reservation in Arizona and astronauts in space! Projects like STARPAHC drove research in medical engineering, and helped expand advancements in telemedicine. The next few decades saw continued innovations in telemedicine and wider research at universities, medical centers and research companies.
A pathologist, Ronald S. Weinstein, M.D., coined the term "telepathology" in 1986. In an editorial in a medical journal, Weinstein outlined the actions that would be needed to create remote pathology diagnostic services. He, and his collaborators, published the first scientific paper on robotic telepathology. Weinstein was also granted the first U.S. patents for robotic telepathology systems and telepathology diagnostic networks. Weinstein is known to many as the "father of telepathology". In Norway, Eide and Nordrum implemented the first sustainable clinical telepathology service in 1989. This is still in operation, decades later. A number of clinical telepathology services have benefited many thousands of patients in North America, Europe, and Asia.
“Although technology makes it easier for physicians and patients to communicate with one another, technology does nothing to change the sacred obligation that physicians have to deliver the best care for their patients,” he explained. “Our best physician users of telemedicine are those that embrace it as a way to be more efficient themselves, to be more respectful of patients’ time, and to reach a greater number of patients.”
To keep up with the rate that technology is progressing, the telemedicine will of course need to overcome other administrative barriers, such as restrictions placed on telemedicine practice by state legislation, state-specific licensing requirements by medical boards, and the reimbursement policies that affect whether doctors are reimbursed by payers and patients are not out-of-pocket. But with the projection that telemedicine will be a $36.3 billion industry by 2020, over 50 telehealth-related bills in the 113th Congress, and 75% of surveyed patients reporting interest in telemedicine, telemedicine’s future is bright and demand is likely to overcome these barriers.
Telehealth is defined as the delivery and facilitation of health and health-related services including medical care, provider and patient education, health information services, and self-care via telecommunications and digital communication technologies. Live video conferencing, mobile health apps, “store and forward” electronic transmission, and remote patient monitoring (RPM) are examples of technologies used in telehealth.
Synchronous, real-time or Clinical Video Telehealth requires the presence of both parties at the same time and a communication link between them that allows a real-time interaction to take place. Video-conferencing equipment is one of the most common forms of technologies used in synchronous telehealth. There are also peripheral devices that can be attached to computers or the video-conferencing equipment which can aid in an interactive examination.
Telemedicine is the use of telecommunication and information technology to provide clinical health care from a distance. It has been used to overcome distance barriers and to improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care and emergency situations.
Without a doubt, the emergency room is one of the most expensive, overcrowded, and stressful environments in healthcare. With telemedicine, overcrowded emergency rooms can be reduced by having patients see a remote physician using video chat first. The remote physician can determine if that individual should seek care in an emergency department, which increases ED efficiency.
Telepsychiatry – Telepsychiatry allows qualified psychiatrists to provide treatment to patients remotely, expanding access to behavioral health services. Telepsychiatry is incredibly popular, in part because of the nation-wide shortage of available psychiatrists, and because psychiatry often does not require the same physical exams of the medical field.
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.
Did you know that there are different types of telemedicine? That’s right, there are a few different ways that healthcare systems can use telemedicine to assist patients. As discussed in previous articles, telemedicine is the method of using telecommunications to connect patients and providers over a distance. Today, there are three different types of telemedicine used and it includes the following:
As various parties seek more efficient ways to provide care at less cost to the patient, telemedicine's role has grown. It is often a time-saving way for a consumer to see and speak to a clinician for minor and non-urgent medical needs instead of going to a primary care physician's office or emergency department. In recent years, many states have passed laws that make telemedicine easier to practice, and federal health regulators are also exploring ways to further grant Medicare reimbursements for telemedicine services.
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.
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.
A landmark 2010 report by the World Health Organization found that telemedicine – literally meaning “healing from a distance” — can be traced back to the mid-1800s, was first featured in published accounts early on in the 20th Century, and adopted its modern form in the late 1960s and early 1970s, primarily through the military and space industries. Owing to the fact that much of the technology encompassed in today’s telemedicine platform wasn’t around back then, and noting a 2007 study that found 104 different peer-reviewed definitions for the word, the WHO settled on its own broad-based definition:
Video chatting has become ubiquitous with technology advances such as 4G internet speeds, low-cost smartphones and standardized phone operating systems. The advent of additional technology standards such as interoperable electronic health records (EHR), secure cloud storage (HIPAA), and wearable health trackers that can communicate with the smartphone has further incentivized consumers to jump on to the telehealth bandwagon. Perhaps the ultimate goal of telehealth is to bring continuous care to consumers while they are working or at home, years before they end up in a clinic.
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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.
Before setting up a telemedicine practice, an organizations administration and providers should know how laws differ when using telemedicine solutions. They should also consult with an expert to determine what equipment they need, and have a basic understanding of why they want to offer this in the first place. In addition, if it’s an existing practice, they should get buy-in as some physicians are not ready to make the transition.
In addition to medical assistance, there are psychologists and psychiatrists you can schedule appointments with for online therapy. They treat depression, additions, social anxiety, trauma and workplace stress as well as social issues. Like the doctors, psychiatrists can prescribe medication. Doctor on Demand provides an online assessment to help you determine if you could benefit from telepsychology.
ECGs, or electrocardiographs, can be transmitted using telephone and wireless. Willem Einthoven, the inventor of the ECG, actually did tests with transmission of ECG via telephone lines. This was because the hospital did not allow him to move patients outside the hospital to his laboratory for testing of his new device. In 1906 Einthoven came up with a way to transmit the data from the hospital directly to his lab. See above reference-General health care delivery. Remotely treating ventricular fibrillation Medphone Corporation, 1989
“For the most part, an interaction — whether in person, via telemedicine or on the phone — between a patient and a physician can be beneficial,” Downey wrote in a 2015 blog. “The sticking point is the issuance of a prescription medication to a previously unknown person who the doctor has never examined and for which the doctor has no access to the medical record. And here's where telemedicine differs from telehealth. During a telemedicine visit, the patient is seen by the provider. A patient presenter is with the patient in most cases, and follows the directions of the remote provider in placing a stethoscope or exam camera on the patient's body, providing both sounds and images. The remote provider also has the benefit of an array of other medical devices to gather patient information not available to a D2C telehealth physician.”
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.
According to an SEC filing relating to its recent fundraising round, Teladoc brings in between $25 million and $100 million in sales. The company is also experimenting with taking a cut of the cost savings it delivers to health plans, which could boost revenue further. Revenue grew 75% in 2012, 100% in 2013 and is expected to grow another 100% this year, Gorevic says.
*Teladoc does not guarantee that a prescription will be written. Teladoc does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc operates subject to state regulations and may not be available in certain states. Teladoc does not replace the primary care physician. Teladoc physicians are U.S. board-certified in internal medicine, family practice, emergency medicine or pediatrics and reserve the right to deny care for potential misuse of services. Teladoc consultations are available 24 hours, 7 days a week. ©2016 Teladoc, Inc. All rights reserved. Teladoc and the Teladoc logo are trademarks of Teladoc, Inc. and may not be used without written permission.
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.
The amount providers are reimbursed for telemedicine will vary depending on a state’s legislation. Some states specifically mandate that private payers reimburse the same amount for telemedicine as if the service was provided in-person. However, most states with reimbursement mandates leave this determination up to the payers. We have found the majority of private payers still reimburse at levels equivalent to in-person visits.
Informed consent is another issue – should the patient give informed consent to receive online care before it starts? Or will it be implied if it is care that can only practically be given over distance? When telehealth includes the possibility for technical problems such as transmission errors or security breaches or storage which impact on ability to communicate, it may be wise to obtain informed consent in person first, as well as having backup options for when technical issues occur. In person, a patient can see who is involved in their care (namely themselves and their clinician in a consult), but online there will be other involved such as the technology providers, therefore consent may need to involve disclosure of anyone involved in the transmission of the information and the security that will keep their information private, and any legal malpractice cases may need to involve all of those involved as opposed to what would usually just be the practitioner.
Devices are also being used to track blood glucose levels and report high or low levels to patients and providers. In partnership with Stanford, Apple is testing whether its Apple Watch can be used to detect irregular heart patterns, and AliveCor’s KardiaBand allows Apple Watch wearers to perform electrocardiograms in 30 seconds that can easily be transmitted to physicians. Patients often go months without seeing their providers. RPM can allow for earlier detection of complications and identify patients who need to seek medical attention prior to in-person appointments. Moreover, chronic conditions can be more readily and efficiently managed resulting in higher quality care and outcomes as well as reduced costs.
Doctor on Demand is currently available for patients in 15 states, including large states like California, Florida, New Jersey, New York, Ohio, and Texas. The company has more than 1,000 doctors available for video consultants one or two days a week, according to Bloomberg Businessweek. The company trains physicians on how to use the service, and covers other logistics like patient questionnaires and malpractice insurance.
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 first radiologic images were sent via telephone between two medical staff at two different health centers in Pennsylvania by 1948. The health centers were 24 miles apart from one another! Then in 1959, physicians at the University of Nebraska transmitted neurological examinations across campus to medical students using two-way interactive television. Five years later, a closed-circuit television link was built that allowed physicians to provide psychiatric consultations 112 miles away at Norfolk State Hospital.
A major legal action prompt in telehealth thus far has been issues surrounding online prescribing and whether an appropriate clinician-patient relationship can be established online to make prescribing safe, making this an area that requires particular scrutiny. It may be required that the practitioner and patient involved must meet in person at least once before online prescribing can occur, or that at least a live-video conference must occur, not just impersonal questionnaires or surveys to determine need.
This type of telemedicine allows providers to share patient information with a practitioner in another location. For example, a primary care physician can now share patient records and medical data with a specialist without being in the same room. Systems can transmit information across vast distances and different systems (sometimes) so one physician can know what another has already done. This leads to less duplicate testing and fewer instances of poor medication management.
Telehealth allows the patient to be monitored between physician office visits which can improve patient health. Telehealth also allows patients to access expertise which is not available in their local area. This remote patient monitoring ability enables patients to stay at home longer and helps avoid unnecessary hospital time. In the long-term, this could potentially result in less burdening of the healthcare system and consumption of resources.
Like most telemedicine tools, remote patient monitoring solutions make it easier for patients and physicians to maintain close communication. Many RPM solutions record and transmit a patient’s medical data automatically, generating a regular report for the physician. In some cases, this medical data is transmitted to a team of health monitoring professionals who are responsible for flagging any warning signs and sending them on to the physician, if needed.
As the CCHP notes, different organizations have different definitions for telehealth. California very specifically defines it as “the mode of delivering healthcare services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management and self-management of a patient's healthcare while the patient is at the originating site and the healthcare provider is at a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.” The Health Resources and Services Administration (HRSA), meanwhile, defines it as “the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health and health administration.”
Telehealth has emerged as a critical tool in providing health care services.  The practice covers a broad range of medical technology and services that collectively define the discipline. Telehealth is especially beneficial for patients who live in rural communities and other remote areas where medical professionals use the Internet to gather and share information as well as monitor the health conditions of patients by using peripheral equipment and software such as video conferencing devices, store-and-forward imaging, and streaming media. The following information details important factors that are shaping this burgeoning field.
In the United States, the major companies offering primary care for non-acute illnesses include Teladoc, American Well, and PlushCare. Companies such as Grand Rounds offer remote access to specialty care. Additionally, telemedicine companies are collaborating with health insurers and other telemedicine providers to expand marketshare and patient access to telemedicine consultations. For example, In 2015, UnitedHealthcare announced that it would cover a range of video visits from Doctor On Demand, American Well's AmWell, and its own Optum's NowClinic, which is a white-labeled American Well offering. On November 30, 2017, PlushCare launched in some U.S. states, the Pre-Exposure Prophylaxis (PrEP) therapy for prevention of HIV. In this PrEP initiative, PlushCare does not require an initial check-up and provides consistent online doctor visits, regular local laboratory testing and prescriptions filled at partner pharmacies.
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 downsides of telemedicine include the cost of telecommunication and data management equipment and of technical training for medical personnel who will employ it. Virtual medical treatment also entails potentially decreased human interaction between medical professionals and patients, an increased risk of error when medical services are delivered in the absence of a registered professional, and an increased risk that protected health information may be compromised through electronic storage and transmission. There is also a concern that telemedicine may actually decrease time efficiency due to the difficulties of assessing and treating patients through virtual interactions; for example, it has been estimated that a teledermatology consultation can take up to thirty minutes, whereas fifteen minutes is typical for a traditional consultation. Additionally, potentially poor quality of transmitted records, such as images or patient progress reports, and decreased access to relevant clinical information are quality assurance risks that can compromise the quality and continuity of patient care for the reporting doctor. Other obstacles to the implementation of telemedicine include unclear legal regulation for some telemedical practices and difficulty claiming reimbursement from insurers or government programs in some fields.
Telehealth, the use of electronic communication to remotely provide health care information and services, is gaining more and more attention as providers, patients, and payers all seek more effective and cost-efficient ways to deliver care. Physical therapy is no exception, and while those services have developed mostly in rural areas to accommodate the long distances between patients and providers, telehealth in physical therapy is being considered in other geographic and clinical settings.
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.
With approximately 30-million cases of thyroid conditions across the U.S., including some 15-million which are undiagnosed, the need for fast and efficient prescriptions in this area is high. Women have a higher chance of contracting disorders of the thyroid, but they can affect men as well. Symptoms include anxiety, chronic fatigue syndrome, numbed senses of smell and taste, lowered sex drive, dry skin, stomach pain, digestive issues, high blood pressure, pain in the joints and muscles, heart palpitations, weight gain, hair loss, and uncontrollable body temperature.