Obamacare—or the Affordable Care Act, as it is officially called—has been a catalyst for Teladoc’s recent growth surge. The law puts pressure on doctor’s offices, who are seeing more patients, as well as employers, who are looking to cut healthcare costs. As a result, telemedicine is becoming increasingly popular as a cheaper alternative to going to the emergency room. Insurance companies including Aetna (AET), Blue Shield of California and Oscar—which offers Obamacare plans on New York’s health exchange—have recently signed on with Teladoc, as have Home Depot (HD), T-Mobile (TMUS), pension giant CalPERS, and others.
In April 2012, a Manchester-based Video CBT pilot project was launched to provide live video therapy sessions for those with depression, anxiety, and stress related conditions called InstantCBT[56] The site supported at launch a variety of video platforms (including Skype, GChat, Yahoo, MSN as well as bespoke)[57] and was aimed at lowering the waiting times for mental health patients. This is a Commercial, For-Profit business.

Online medical care might not be the doctors and nurses of your parents’ time, but it is a huge advancement that will help care for your parents’ future. Geriatric care is greatly impacted by the mobility of older patients and using technology-based doctor appointments is a much-needed solution. So, is this new-fangled approach to healthcare here to stay? It sure looks that way!
Hypertension disorder affects approximately one third of the adult population in the United States. The cause usually stems from improper nutrition, obesity, cigarette smoke, alcohol abuse, high sodium intake, and a lack of regular physical activity. While making life changes can eventually lower blood pressure to a healthy level once more, it is sometimes necessary to treat the issue with a prescription medication.

Remote patient monitoring, which is sometimes called self-monitoring or self-testing, is a means of monitoring patient health and clinical information at a distance. It helps to simplify patient compliance with testing and it lowers the cost of frequent monitoring. It is frequently used in the treatment and management of chronic illnesses like asthma, cardiovascular disease, and diabetes.


“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.”

NewYork-Presbyterian is making investments in all of these because it believes telemedicine and virtual medicine in general will make delivery of care more efficient and higher-quality in the long run, he explained. Each telemedicine modality has its own associated cost and reimbursement, and the organization is making decisions on where to put its efforts not based on net revenue but on the impact that each will have for patients, he added.
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.
The laws regarding reimbursements change regularly as more service providers incorporate telehealth technology into their practices. Reimbursement procedures can vary by state, practice, insurer, and service. [3] Care providers need to understand several facts, regulations, and laws to navigate Medicare telehealth reimbursements. They must first scrutinize whether the distance between the facility (the originating site) and the patient is far enough to qualify as a distant site. The location must also qualify as a Health Professional Shortage Area (HPSA) per Medicare guidelines. Additionally, the originating site must fall under Medicare’s classification as a legally authorized private practice, hospital, or critical access hospital (CAH). For instance, the Centers for Medicare and Medicaid Services ranks the Harvard Street Neighborhood Health Center as a top facility in need of physician services based on these criteria. Care providers must also use proper insurance coding to be reimbursed for hosting services that use telehealth technologies. For now, collecting reimbursements for telehealth services remains simpler for practitioners who limit the scope to which they apply the technology.
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.
Dr. Bernstein has practiced medicine since 1990 and provided virtual care with our team since 2006. He received his medical degree from the University of North Carolina and completed a residency at Providence Family Practice in Seattle. He also holds a Master's Degree in Public Health from the University of Washington. Dr. Bernstein is dedicated to quality preventive medicine, public health promotion, and research. As Director of Clinical Quality, he manages the development and maintenance of the clinical standards of patient care, working with the development team to create new systems for measuring clinical delivery effectiveness. In his spare time, he is an avid cyclist and a soccer fan.
This expectation for more convenient care, combined with the unavailability of many overburdened medical professionals (especially primary care providers) have led to the rise of telemedicine companies. Many offer patients 24/7 access to medical care with an on-call doctor contracted by that company. Others offer hospitals and larger health centers access to extra clinical staff and specialists, for outsourcing of special cases (common model among teleradiology companies). Still others provide a telemedicine platform for physicians to use to offer virtual visits with their own patients. Increasingly, telemedicine is becoming a way to give medical practices an edge in a competitive healthcare landscape where it’s difficult to stay independent or maintain a healthy bottom line.
Telehealth Addresses Primary Care Physician Shortages/Specialist Scarcity: Telehealth is allowing patients at smaller, less-resourced hospitals to gain access to specialists based at larger regional facilities. Undeniably, lack of access and hard-to-reach populations are drivers of telehealth innovations as supported by this 2014 MUSC study on the use of telehospitalists to address physician shortages. Telehealth is being implemented to treat prison populations, as well as being deployed in rural communities and underserved urban areas to improve healthcare availability.

Telemedicine solutions that fall into the remote patient monitoring (RPM) allow healthcare providers to track a patient’s vital signs and other health data from a distance. This makes it easy to watch for warning signs and quickly intervene in patients who are at health-risk or are recovering from a recent surgery, for example. This type of telemedicine is sometimes also called telemonitoring or home telehealth.
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.

Clinicians are conquering distance and providing access to patients who are not able to travel by providing appointments utilizing real-time video communication platforms. Video conferencing technology has been utilized to provide care for inmates, military personnel, and patients located in rural locations for some time. Also, suppliers of both care and financing such as Kaiser Permanente, the Defense Department, and the Department of Veterans Affairs have been exploiting telehealth modalities to increase access to healthcare services and promote better care quality. In another example, S.C. Department of Corrections and the Medical University of South Carolina are using video scopes and high-resolution cameras to diagnose and treat inmates remotely. They are also conducting virtual appointments using video/audio communication applications to reduce prisoner transportation costs and increase safety by keeping inmates in and providers out of correctional facilities.
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.
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.
Medicare pays for telemedicine services under certain circumstances. Primarily, Medicare covers live telemedicine services, or virtual visits delivered via interactive audio and video (think videochat). The goal is to cover medical services delivered virtually where an in-person visit may be difficult for the patient or provider. Store-and-forward telemedicine services are only covered in Hawaii and Alaska at this time.
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.
Teleneuropsychology (Cullum et al., 2014) is the use of telehealth/videoconference technology for the remote administration of neuropsychological tests. Neuropsychological tests are used to evaluate the cognitive status of individuals with known or suspected brain disorders and provide a profile of cognitive strengths and weaknesses. Through a series of studies, there is growing support in the literature showing that remote videoconference-based administration of many standard neuropsychological tests results in test findings that are similar to traditional in-person evaluations, thereby establishing the basis for the reliability and validity of teleneuropsychological assessment.[30][31][32][32][33][34][35]
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.
For purposes of Medicaid, telemedicine seeks to improve a patient's health by permitting two-way, real time interactive communication between the patient, and the physician or practitioner at the distant site. This electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment.

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.
Store-and-forward is the oldest form of telehealth technology. It refers to the transmission of images or information from one provider to another. For example, if your doctor sends digital images of an x-ray to a radiologist for analysis, they are leveraging store-and-forward telehealth technology. This is one of the most common uses, but images and information of any type can be transmitted in this matter. One thing we should point out, however, is that store-and-forward telehealth is not always covered by state telemedicine reimbursement laws, even in states that require parity for real-time communication.

Flexibility & work/life balance Very open organization with immediate access to executive leadership Transparent and communicative Promotes within organization Celebrates employee milestones and company wins Good benefits Salaries are competitive (at least to my knowledge) Open to new ideas Organization is doing very well and growing really fast Work being done has a positive influence on the current healthcare...
Telehealth specialists with specialized training in talking with patients and diagnosing over the phone and via online video, while adhering to Teladoc's set of 130 proprietary, evidence-based, clinical practice guidelines for the telephonic and audio-video treatment of common, uncomplicated medical conditions (the only guidelines in the industry specific to telehealth).
But as the National Policy Telehealth Resource Center notes, “Compliance with the Health Insurance Portability and Accountability Act (HIPAA) is more complex than simply using products that claim to be ‘HIPAA-compliant.” Not only does the telemedicine platform need to be compliant, all providers, patients, and staff using the tool need to ensure they are in compliance with HIPAA. A telemedicine software vendor, for instance, not only needs to build a secure product, but also ensure their company is operating in accordance with HIPAA.
There certainly has been a lot of excitement around how novel digital technology can change the patient-provider relationship. A recent survey found that 64% of patients are willing to have video visits with their physicians, and the telehealth industry is expected to expand 10-fold by 2018. Apps like Doctor on Demand could play a major role in bringing telehealth mainstream; notably, Richard Branson (the man behind the Virgin Group empire), has recently invested in Doctors On Demand. The biggest benefits of virtual health apps are in lowering costs and saving time, particularly for those who cannot access care nearby. In a disease like diabetes, where blood glucose data can be analyzed remotely, there certainly is a lot of potential for technology to improve care. For more information on the role of virtual health in diabetes, check out our conference pearls from AADE 2014. –AJW/KC/AB

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.
Telehealth is sometimes discussed interchangeably with telemedicine. The Health Resources and Services Administration distinguishes telehealth from telemedicine in its scope. According to them, telemedicine only describes remote clinical services; such as diagnosis and monitoring, while telehealth includes preventative, promotive and curative care delivery.[1] This includes the above-mentioned non-clinical applications like administration and provider education which make telehealth the preferred modern terminology.[2]
Oxford’s telemedicine definition is “the remote diagnosis and treatment of patients by means of telecommunications technology.” Telemedicine encompasses the use of technologies and telecommunication systems to administer healthcare to patients who are geographically separated from providers. For example, a radiologist may read and interpret the imaging results for a patient in a different county whose hospital does not currently have a radiologist on staff. Or a physician may conduct an urgent-care consultation via video for a non-life-threatening condition.
There certainly has been a lot of excitement around how novel digital technology can change the patient-provider relationship. A recent survey found that 64% of patients are willing to have video visits with their physicians, and the telehealth industry is expected to expand 10-fold by 2018. Apps like Doctor on Demand could play a major role in bringing telehealth mainstream; notably, Richard Branson (the man behind the Virgin Group empire), has recently invested in Doctors On Demand. The biggest benefits of virtual health apps are in lowering costs and saving time, particularly for those who cannot access care nearby. In a disease like diabetes, where blood glucose data can be analyzed remotely, there certainly is a lot of potential for technology to improve care. For more information on the role of virtual health in diabetes, check out our conference pearls from AADE 2014. –AJW/KC/AB

The creation of telemedicine began with the inception of the telecommunications infrastructure, which included the telegraph, telephone, and radio. Casualties and injuries were reported using the telegraph during the Civil War, in addition to the ordering of medical supplies and consultations. This is considered one the earliest adoptions of telemedicine technology.

ISDN Basic Rate Interface (BRI): A type of ISDN interface that provides 128K of bandwith tht is used for videoconferencing as well as simultaneous data and voice services. A multiplexer can be used to link together multiple BRI lines in order for higher bandwidth levels to be achieved. For example, one popular option among telehealth networks is combining 3 BRI lines in order for video-conferencing to be provided with 384K of bandwidth. BRI services are unavailable in some rural areas. Before videoconferencing equipment is order for using this kind of service, one needs to check with their telecommunications provider to see if BRI services are available.
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.
Teleradiology is the ability to send radiographic images (x-rays, CT, MR, PET/CT, SPECT/CT, MG, US...) from one location to another.[62] For this process to be implemented, three essential components are required, an image sending station, a transmission network, and a receiving-image review station. The most typical implementation are two computers connected via the Internet. The computer at the receiving end will need to have a high-quality display screen that has been tested and cleared for clinical purposes. Sometimes the receiving computer will have a printer so that images can be printed for convenience.

“Creating a viable telemedicine program is both a short-term and a long-term proposition,” said Daniel Barchi, CIO at New York-Presbyterian. “It is possible, with a small team and early investment of resources, to create telemedicine capability in a specific vertical. It could be post-surgical follow-up visits for patients and surgeons, medication reconciliation video visits with a pharmacist, or urgent care emergency department video calls.”
In the future, experts say, internet-­connected sensors—such as blood pressure monitors—could be paired with e-visits to help people manage chronic conditions from home. So far, such devices aren't widely used. But the list of conditions that patients and doctors can manage remotely is “ever expanding,” says Eric Topol, M.D., director of the Scripps Translational Science Institute.
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