Telehealth requires a strong, reliable broadband connection. The broadband signal transmission infrastructure includes wires, cables, microwaves and optic fibre, which must be maintained for the provision of telehealth services. The better the connection (bandwidth quality), the more data can be sent and received. Historically this has priced providers or patients out of the service, but as the infrastructure improves and becomes more accessible, telehealth usage can grow.[1][2]
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.
Teleradiology – Teleradiology is actually one of the earliest fields of telemedicine, beginning in the 1960s. Teleradiology solutions were developed to expand access to diagnosticians of x-rays. Smaller hospitals around the U.S. may not always have a radiologist on staff, or may not have access to one around the clock. That means patients coming into the ER, especially during off-hours, will have to wait for diagnosis. Teleradiology solutions now offer providers at one location to send a patient’s x-rays and records securely to a qualified radiologist at another location, and get a quick consult on the patient’s condition.
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.

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.
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.
“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.”
A tool that makes healthcare more accessible, cost-effective, and that increases patient engagement – is telemedicine. Since making its debut in the late 1950’s, advances in telemedicine has contributed to seniors having the choice to age in place. In addition, the patients that reside in rural areas that previously had difficulties accessing a physician, can now reach them virtually.
This service removes the need for impromptu walk-in clinic visits, lengthy waiting room stays, and long lines at the pharmacy. It also creates a safe space without judgment or the need to explain your condition to multiple strangers before you receive a prescription. Our professional and experienced team takes great care to make you feel comfortable and protected as your medical needs are met and your prescription is written, sent, and filled.

SSM Health telehealth programs use a variety of applications and services including two-way video, email, smart phones, wireless tools and other forms of telecommunications technology. These modern communication pipelines offer practitioners a channel to interact with the patient and exchange information, pictures and video. Our telehealth programs:
In 1964, the Nebraska Psychiatric Institute began using television links to form two-way communication with the Norfolk State Hospital which was 112 miles away for the education and consultation purposes between clinicians in the two locations.[9] The Logan International Airport in Boston established in-house medical stations in 1967. These stations were linked to Massachusetts General Hospital. Clinicians at the hospital would provide consultation services to patients who were at the airport. Consultations were achieved through microwave audio as well as video links.[5][9]
Telehealth requires a strong, reliable broadband connection. The broadband signal transmission infrastructure includes wires, cables, microwaves and optic fibre, which must be maintained for the provision of telehealth services. The better the connection (bandwidth quality), the more data can be sent and received. Historically this has priced providers or patients out of the service, but as the infrastructure improves and becomes more accessible, telehealth usage can grow.[1][2]

Although, traditional medicine relies on in-person care, the need and want for remote care has existed from the Roman and pre-Hippocratic periods in antiquity. The elderly and infirm who could not visit temples for medical care sent representatives to convey information on symptoms and bring home a diagnosis as well as treatment.[5] In Africa, villagers would use smoke signals to warn neighbouring villages of disease outbreak.[6] The beginnings of telehealth have existed through primitive forms of communication and technology.[5]
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.

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.
Where telemedicine refers specifically to the practice of medicine via remote means, telehealth is a blanket term that covers all components and activities of healthcare and the healthcare system that are conducted through telecommunications technology. Healthcare education, wearable devices that record and transmit vital signs, and provider-to-provider remote communication are examples of telehealth activities and applications that extend beyond remote clinical care.
Telemedicine is an important and quickly growing component of healthcare delievery in the United States.  There are currently about 200 telemedicine networks, with 3,500 service sites in the US.  In 2011 alone the Veterans Health Administration delivered over 300,000 remote consultations using telemedicine. More than half of all U.S. hospitals now use some form of 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.

Store-and-forward telemedicine involves acquiring medical data (like medical images, biosignals etc.) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline.[3] It does not require the presence of both parties at the same time.[1] Dermatology (cf: teledermatology), radiology, and pathology are common specialties that are conducive to asynchronous telemedicine. A properly structured medical record preferably in electronic form should be a component of this transfer. A key difference between traditional in-person patient meetings and telemedicine encounters is the omission of an actual physical examination and history. The 'store-and-forward' process requires the clinician to rely on a history report and audio/video information in lieu of a physical examination.
“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.”
Effective September 1, 2018, the AlaskaCare Employee Health Plan has partnered with Teladoc® to provide you with a convenient and affordable way to receive quality medical care. Teladoc® lets you talk with experienced doctors by phone or video anytime, anywhere. All Teladoc® doctors are board-certified, state-licensed and can treat many health issues, including:
This isn't to say that you should jump right in and begin providing services via telehealth. You'll first need to consider federal and state legislation and regulations that govern your practice, risk management implications, billing and coding issues, and hardware/software requirements. The resources below aren't meant to give you detailed instructions on developing and using telehealth in your practice, but they identify areas most important for you to investigate and consider.
Facility Fees. In addition to reimbursement for the telemedicine service, Medicare will pay the originating site a facility fee. For example, if you’re a primary care provider with a patient in your office and you do a telemedicine visit to consult a physician in another location, you could bill for two separate things – the telemedicine service, and a facility fee for using your practice to “host” of the patient visit. Check HCPCS code Q3014 for a full description on facility fees.
VSee urges organizations to try their free app so physicians can get a feel for sharing medical documents and streaming digital device images. In addition, organizations should ensure they have compatible microphones, webcams, speakers, and more. A telemedicine tech should be identified within the practice to help others get acclimated and resolve tech issues. Also, practices should be aware of their Internet connection. VSee’s video chat is robust, but how well it works comes down to the Internet connection and computer capabilities.
How much and which telemedicine services private payers pay for again can vary widely by state. While the trend is toward broader coverage of telemedicine services for plan enrollees, private payers are still deciding on exactly what they will cover and what they won’t. 29 states and Washington, DC have passed telemedicine parity laws, which mandate that private payers in those states pay for telemedicine services at the same rate as in-person visits.

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.

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.
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