What we recognize as telemedicine today started in the 1950’s when a few hospital systems and university medical centers started to try to find ways to share information and images via telephone. In one of the first successes, two health centers in Pennsylvania were able to transmit radiologic images over the phone.
In the early days, telemedicine was used mostly to connect doctors working with a patient in one location to specialists somewhere else. This was of great benefit to rural or hard to reach populations where specialists aren’t readily available. Throughout the next several decades, the equipment necessary to conduct remote visits remained expensive and complex, so the use of the approach, while growing, was limited.
The rise of the internet age brought with it profound changes for the practice of telemedicine. The proliferation of smart devices, capable of high-quality video transmission, opened up the possibility of delivering remote healthcare to patients in their homes, workplaces or assisted living facilities as an alternative to in-person visits for both primary and specialty care.
Although the terms telemedicine and telehealth are often used interchangeably, there is a distinction between the two.
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.”
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.
Using telemedicine as an alternative to in-person visits has a host of benefits for patients and providers alike.
There are few limitations to how telemedicine can be applied. Here are a few examples of how it is being used today.
Using health software for routine follow-up visits is not only more efficient for providers and patients, but it also increases the likelihood of follow-up, reducing missed appointments and improving patient outcomes.
Remote chronic disease management
The increasing rate of chronic disease is a major challenge for our health system. It is a prime candidate for the use of telemedicine software because it makes it easier and less expensive for patients to maintain control over their health.
Remote post-hospitalization care
One telehealth program for patients with congestive heart failure reduced 30-day hospital readmissions by 73 percent and six-month readmissions by 50 percent.
Preventative care support
Weight loss and smoking cessation are the keys to reducing heart disease and a host of other conditions. Telemedicine can be a valuable tool in connecting providers with patients to make sure they get the support they need to be successful.
School based telehealth
When children become ill at school, they might visit a school nurse or be picked up by their parents and taken to an urgent care center. Some innovative districts have teamed up with doctors to conduct remote visits from the school. The provider can assess the urgency of the case and provide instructions or reassurance to parents.
Assisted living center support
Telemedicine software has already proven to be useful in keeping residence of assisted living facilities out of the hospital. Problems often occur at night or on weekends, making hospitalization the only option even for less urgent problems. With telemedicine, on-call doctors can conduct a remote visit to determine if hospitalization is necessary.
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.
Because patient data will be transmitted when telemedicine is used, it is subject to HIPAA regulations. Consumer video services like Skype and Facetime do not meet this standard. In order to maintain compliance, providers must choose technology solutions that use data encryption to protect patient data.
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.
Yes. When used under the right conditions and for appropriate cases, telemedicine has been shown to be as safe and effective as in-person care. Of course, not every condition is conducive to treatment via video visits, so providers must use good judgement when leveraging this channel for healthcare delivery.
For Medicare patients, national telehealth policy sets many restrictions on patient location, services provided over telemedicine and facilities at which patients receive these services. However, the Medicare Chronic Care Management Program is a national policy that set no such restrictions on practicing telemedicine.
Medicaid reimbursement varies from state to state, resulting in a patchwork of different policies and reimbursement requirements.
In order to be effective, telemedicine technologies must be easy to use for both patients and providers. The best solutions are easy for medical offices to set up and deploy and as easy for patients as the mobile device applications they use every day.