Telemedicine refers to the practice of using telecommunications technology to evaluate, diagnose and care for patients at a distance. Although the approach has been around for decades in limited fashion, it is quickly becoming an important and mainstream channel of healthcare delivery in the United States.
Telemedicine is not a separate medical specialty. Rather, it is a method of providing clinical care. Included in telemedicine are patient consultations conducted through audio and video conferencing, remote monitoring of vital signs, nurse advice lines, transmission of images, and test results.
Although the terms telemedicine and telehealth are often used interchangeably, technically telemedicine is a subset of telehealth. Telehealth includes non-clinical activities such as medical education, administrative meetings, and provider training. Both telehealth and telemedicine are part of an even larger range of technologies known as Healthcare Information Technology (HIT), which also includes patient management systems and digital medical records.
A wide variety of clinical services are provided using telemedicine technologies.
Primary and Follow Up Care: In many cases, a remote visit using high definition video and audio conferencing can replace an in-person visit to the doctor’s office. The patient and provider connect using an application designed for the purpose. The patient may participate using a personal computer or smart mobile device. In this case, the patient can be anywhere that offers sufficient privacy.
Specialist Consultations: Telemedicine can also be used to leverage the expertise of specialists who are not physically present. The patient may be in the office of their primary physician when a video visit is conducted. Alternatively, the primary physician may use a telemedicine approach known as store-and-forward to provide relevant information to the specialist for evaluation.
Urgent Care: Both stand alone urgent care clinics and primary physician’s offices are leveraging telemedicine to provide urgent care services. Many urgent, but non-life threatening conditions can effectively be diagnosed and treated remotely, keeping patients out of crowded emergency rooms and clinics.
Remote Patient Monitoring: Certain conditions, such as heart disease and diabetes, can best be managed with real-time information about patient vital signs and activities. Telemedicine technology can be used to transmit and store this type of data.
Psychiatric Services and Counseling: Telemedicine is ideally suited for psychiatric services, cognitive behavioural therapy, and lifestyle coaching, including weight management and smoking cessation.
School Based Healthcare: Schools have found that telemedicine is an effective way to get students necessary medical attention with minimal interruption to their school day.
Assisted Living Support: Care teams at assisted living centers and skilled nursing facilities can receive the support of remote providers via video, making it possible to get patients the care they need without the complexity of transportation.
Online Only Medical Services: A growing number of companies provide online only access to physicians and nurse practitioners. Patients can simply access a website and receive care for a limited number of conditions on-demand.
There are a few factors that have converged to make widespread adoption of telemedicine possible and necessary.
The ubiquity of high-speed internet access and mobile devices: Most people now have access to the technology necessary for telehealth. Not only do people already have computers and smart devices that can access the internet, they are also used to using telecommunications technology in other contexts.
The Affordable Care Act: The ACA has made it possible for approximately 16 million more people to become insured. In order to service them, the healthcare system must become more efficient. Telemedicine is one way of caring for more patients with the same resources.
The aging of the population: By 2050 the United States is expected to have 83.7 million people over age 65. Older patients generally require more care than their younger counterparts. Providing efficient and cost effective care to this portion of the population is a major challenge facing the entire healthcare system. Telehealth has a large role to play in meeting it.
Evolving laws and payer policies: Many states have adopted laws that require private payers to cover visits conducted via telemedicine. Insurance companies recognize the efficiency and cost effectiveness of telemedicine and are increasingly providing coverage on par with in-person visits.