In its mHealth Roadmap, the Health Information and Management Systems Society (HIMSS) muddies the waters a bit. It uses the Health and Human Services Definition for telehealth — “the use of electronic information and telecommunications technologies to support remote clinical healthcare, patient and professional health-related education, public health and health administration” — then goes on to say that “telemedicine usage ranges from synchronous video chat between a patient and a doctor, to conferencing between doctors, to conferencing between doctors and allied health professionals (e.g., nutritionists, physical therapists), to providing live or recorded presentations to groups of patients who are geographically separated.”
“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.”
Telehealth is defined as the use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include video conferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.
The doctors can treat flu symptoms, rashes, allergies, urinary tract infections, and bronchitis—and even prescribe medication—without ever physically seeing the patient. Gorevic says nurses then go back and review the charts to effectively audit the diagnoses and treatment. Teladoc refers about 1% of consultations to the E.R., and 5% to 6% to a primary care physician or urgent care center. (No, you can’t find a new doctor through Teladoc: The company prohibits its doctors from seeing their online patients in real life.) Soon, Teladoc plans to expand its specialty offerings to include dermatology and behavioral health.
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.
$49/visit or co-pay if not fully covered by health plan LiveHealth Online powered by AmericanWell / Vidyo has been picked up by health insurer WellPoint / Anthem. First piloted in 2013 in California and Ohio. WellPoint / Anthem began a mass rollout to several states in 2014 including Minnesota, Virginia, Kentucky, Maine…and most recently, Massachusetts.
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.
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.
All the guidelines and restrictions we’ve listed above are for billing telemedicine through traditional Medicare. Medicare Advantage plans under a commercial payer have complete flexibility to cover telemedicine however they want! This means, Advantage plans may cover telemedicine for your patient and not have any of those restrictions on what qualifies as an eligible originating site. Call the payer and ask what they’ll cover and what their telemedicine guidelines are.

In addition to the parity laws, some states require providers to obtain patient consent before using telehealth services. Failure to obtain patient consent may result in physicians not being paid. Providers also have to be aware that while some states do not legally require consent, if they bill telemedicine through Medicaid, they will need written consent.
The term telehealth includes a broad range of technologies and services to provide patient care and improve the healthcare delivery system as a whole. 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. According to the World Health Organization, telehealth includes, “Surveillance, health promotion and public health functions.”

Point-to-point connections link small remote health centers to one, large, central health facility via high speed internet. This type of telemedicine connection lets smaller or understaffed clinics outsource medical care to specialists at other locations within the same health system. Point-to-point connections are especially common for telepsychiatry, teleradiology, and urgent care services.


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.

Theoretically, the whole health system stands to benefit from telehealth. In a UK telehealth trial done in 2011, it was reported that the cost of health could be dramatically reduced with the use of telehealth monitoring. The usual cost of in vitro fertilisation (IVF) per cycle would be around $15,000, with telehealth it was reduced to $800 per patient.[32] In Alaska the Federal Health Care Access Network which connects 3,000 healthcare providers to communities, engaged in 160,000 telehealth consultations from 2001 and saved the state $8.5 million in travel costs for just Medicaid patients.[33] There are indications telehealth consumes fewer resources and requires fewer people to operate it with shorter training periods to implement initiatives.[10]
Doctor on Demand is a telemedicine service that gives you access to medical doctors 24/7/365 for the treatment of common and worrisome ailments such as urinary tract infections, skin and eye issues, and minor sports injuries. These problems can sometimes lead to trips to the emergency room simply because you cannot get to your doctor in a timely manner. With this service, you register, request a doctor and meet one quickly via your computer or smart device.
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.
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.
^ 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.

“It is less about the technology as it is about delivering medicine via a new medium,” Clement explained. “Luckily, the C-suite is accustomed now to teleconferencing, so they have a feel for the benefits, as well as some of the communication struggles that come with being audio-visual from remote locations. Much like teleconferencing, there are situations where telemedicine will fit and others where it will not: It can’t be looked upon as a silver bullet.”
The evolution and standardization of 5G has been a long process, but the technology could lead to major advancements in numerous areas like the smart home, media consumption, augmented reality, self-driving cars, telemedicine, and more. — Verge Staff, The Verge, "The road to 5G: the biggest news on next-gen mobile networks," 24 Feb. 2017 But now the clinic has expanded services to the surrounding community, offering primary care and specialty care services via telemedicine, including neurology, cardiology and diabetes education. — Maria Clark, NOLA.com, "Ochsner and NASA partner to open a health center at the Michoud Assembly Facility," 21 Mar. 2018 Such speeds are promoted as aiding the development of new technology in the fields of cloud robotics, telemedicine, connected cars and drones, augmented and virtual reality and more. — Ileana Najarro, Houston Chronicle, "Sprint to bring 5G mobile speeds to Houston this year," 27 Feb. 2018 Thus employees lack a strong financial incentive to seek out cheaper options, such as using a telemedicine service to diagnose pinkeye or having a hip replaced at an ambulatory surgery center instead of a hospital. — Joel Klein, WSJ, "The IRS Can Save American Health Care," 1 July 2018 The bill also has provisions meant to encourage telemedicine, and to add doctors to the state VA programs. — Erica Martinson, Anchorage Daily News, "What the new VA health care bill means for Alaska’s veterans," 24 May 2018 When patients report symptoms that are too complex to handle via telemedicine, Lemonaid doctors refund their money and urge them to see a doctor in person. — Rebecca Robbins, STAT, "A startup promised to make health care ‘refreshingly simple.’ Building the business has been anything but," 26 Apr. 2018 Folks can find a telemedicine service by contacting their insurance company (some have their own service) or local medical centers. — Houston Chronicle, "Hookah health news from your very own galaxy," 1 July 2018 The two topics at hand on this day: Whether to subsidize space exploration and whether to increase the use of telemedicine. — Kevin Kelleher, Fortune, "IBM's Jeopardy-Winning AI Is Now Ready to Debate You," 19 June 2018

Each online video chat appointment with a doctor costs patients $40; doctors get $30 of that, with the company taking a $10 cut. Doctors can diagnose illnesses and prescribe medication, but the app and website are not recommended for any patient experiencing a potentially life-threatening emergency medical condition. Doctors also cannot use it to prescribe medications like sedatives and narcotics.


"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 …
Nursing Call Center – This is a centralized office where nurses are the ones who are working. The nurses are responsible for answering telephone calls from patients. They should also make responses to faxes, electronic mails and letters from patients. Nursing call centers may also provide the callers with the basic information regarding their health, but they should not disclose the diagnosis made by the doctors on their conditions. They should not prescribe medications as well. They may just provide basic instructions when patients are having health complaints.
States may submit a coverage SPA to better describe the telemedicine services they choose to cover, such as which providers/practitioners are; where it is provided; how it is provided, etc. In this case, and in order to avoid unnecessary SPA submissions, it is recommended that a brief description of the framework of telemedicine be placed in an introductory section of the State Plan and then a reference made to telemedicine coverage in the applicable benefit sections of the State Plan. For example, in the physician section it might say that dermatology services can be delivered via telemedicine provided all state requirements related to telemedicine as described in the state plan are otherwise met.
A patient might find themselves in need of services from Express Med Refills for a variety of reasons, the most common being inaccessible family doctors. From time to time, even the most dedicated physician takes a vacation, and while most leave a proxy, or address patient needs before departing, there is the odd case of a patient being left in dire need of a prescription refill. Through our website, Americans can gain access to a U.S. registered online doctor, conduct a one on one consultation, and have a prescription sent to a nearby local pharmacy all on the same day.

*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.
Doctor On Demand’s board-certified physicians are available on-demand and by appointment. The typical average wait time to connect with a doctor is under 3 minutes. Doctor On Demand psychologists are available by appointment between the hours of 7am and 10pm and have extensive experience coaching patients through natural disasters and traumatic events.

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.
In-office visits and overnight stays at healthcare facilities can be difficult for individuals in poor health. Telehealth services reduce hospital readmission rates by enabling doctors to monitor patients outside the office. Because of this, many hospitals have already started to include some form of remote monitoring as part of their post-discharge plans. By equipping patients with wearable devices or other wireless technologies, clinicians can monitor vital signs and symptoms and adjust care as needed without an in-office visit. Alignment Healthcare, for example, developed a program to remotely monitor chronically ill and recently discharged patients and reduce 30-day readmission rates. Enrollees were given a package of Bluetooth-enabled monitoring equipment, including a Samsung tablet, blood pressure cuff, pulse oximeter and scale.
Roy Schoenberg, the CEO of American Well, believes that doctors, insurers and employers will increasingly inform their patients about the option to use telemedicine, which will help consumers get over many of their fears. If they've already got a relationship with that doctor, a virtual consult might seem like an easier alternative to getting across town to a doctor's office and sitting in a waiting room.
To date, there are 33 states plus the District of Columbia, that have parity laws that require private payer reimbursement for telemedicine services. All states with parity laws require private payers to pay for video-conferencing. To date, only a few states require reimbursement for store and forward telemedicine. Organizations should also understand that payment for telemedicine services may not equal that of onsite services.
Soon after Alexander Graham Bell patented the telephone in 1876, ideas of using a telephone to communicate with physicians started appearing in the medical literature. However, telemedicine was truly born in the 1950s, when radiologic images were successfully transferred by telephone between West Chester and Philadelphia, Pennsylvania. In the late 1960s and 1970s, telemedicine developed with support from National Aeronautics and Space Administration (NASA), U.S. Public Health Service, Department of Defense and other federal agencies.
Healthcare systems that adopt telemedicine solutions can attest that it requires a lot of time and money. Implementing a new system requires training and sometimes staff members find it difficult to welcome this change. Practice managers, nurses, physicians, and more have to learn how to utilize the system so that practices can see the benefits. Although telemedicine is expensive in the beginning, healthcare systems should see a positive return on investment over time due to more patients and less staff.
As of 2015, Teladoc was the only telemedicine company to be publicly traded on the New York Stock Exchange. In December 2016, the American Hospital Association exclusively endorsed Teladoc's telehealth technology platform. Teladoc now operates its full suite of services 24 hours a day, 365 days a year, by web, phone, or mobile app in 48 of the 50 states.[7]

While Doctor on Demand’s chief executive Adam Jackson says the start-up targets mainly retail customers who pay $40 for 10 minutes or so with a physician, it signed up Comcast , its first major corporate customer which will subsidize its employees video visits. Doctor on Demand has a network of more than 1,400 general practitioners, internists and pediatricians in 47 states. They diagnose simple ailments, such as pink eye, sore throat and allergies. Insurance doesn’t reimburse video consultations, but customers can use pre-tax dollars from their health savings account to pay.
It’s also important to note that many doctors using telemedicine will charge the patient a convenience fee, ranging from $35 – $125 per visit. This fee is direct from the patient and is on top of (or in place of) any reimbursement through a payer. While that means patients are paying out-of-pocket, many of eVisit’s clients have found patients don’t mind, and in fact are happy to pay the additional fee for the convenience.

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.[65] He, and his collaborators, published the first scientific paper on robotic telepathology.[66] Weinstein was also granted the first U.S. patents for robotic telepathology systems and telepathology diagnostic networks.[67] Weinstein is known to many as the "father of telepathology".[68] In Norway, Eide and Nordrum implemented the first sustainable clinical telepathology service in 1989.[69] 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.
We are currently partnered with over 145 facilities across 25 states and have over 12,000 patient encounters annually. Average response time for calls is three minutes, and we use redundant staffing procedures to ensure a medical specialist will always be available to assist your patients. By working together, we can drastically improve patient outcomes and your community’s access to specialty medical services.
There are the typical discussions about balance between expanding vs. deepening what we currently do. Fair arguments on both sides of the discussion. The company tends to be conservative. Unclear decision making can lead to confusion across the company. Some decisions are made by corporate leaders who don't understand the day to day realties. Needs of the company have outgrown some functional leaders. These issues are...

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.


Teladoc charges an annual subscription fee for its service plus a $40 co-pay per video or phone appointment with a doctor, though employers sometimes subsidize or cover the co-pay completely for their employees. Health insurance startup Oscar (co-founded by venture capitalist Joshua Kushner), for one, has promoted its ACA-compliant health plans with the perk of getting to talk to doctors 24 hours a day—through Teladoc—for free.
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.
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.
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.

In-office visits and overnight stays at healthcare facilities can be difficult for individuals in poor health. Telehealth services reduce hospital readmission rates by enabling doctors to monitor patients outside the office. Because of this, many hospitals have already started to include some form of remote monitoring as part of their post-discharge plans. By equipping patients with wearable devices or other wireless technologies, clinicians can monitor vital signs and symptoms and adjust care as needed without an in-office visit. Alignment Healthcare, for example, developed a program to remotely monitor chronically ill and recently discharged patients and reduce 30-day readmission rates. Enrollees were given a package of Bluetooth-enabled monitoring equipment, including a Samsung tablet, blood pressure cuff, pulse oximeter and scale.


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.
×