Telemedicine is a relatively new concept in the health industry, and it’s leaving a lot of people confused. This guide will help you to understand everything you need to know about telemedicine.

History of Telemedicine

Most people think of telemedicine as new, cutting-edge technology because it involves interaction between doctors and patients via video screens. You’ll be surprised to find out that telemedicine goes as far back as 500 BCE in ancient Rome and Greece where human messengers sent medical advice.
Modern telemedicine as we know it is closely linked with the development of information technology and communication.

In April 1924, a Radio News magazine issue showed a patient communicating with a doctor through a television and microphone. This concept would soon be the future, even though American homes were only just adopting the radio and a lot of people didn’t have televisions.

By the late 1950s and early 1960s, video transmission in telemedicine started with the University of Nebraska leading the charge. The rise of the internet in the 1990s fostered more development to bring about telemedicine as we know it today.

What is Telemedicine

Telemedicine is the use of tools that allow patients to receive healthcare and improve engagement with telecommunication technologies. This technology makes it easier for people in rural and remote areas to receive treatment without traveling long distances. Physicians can easily communicate with their patients in real-time and relay important information for their well-being.

Telemedicine’s popularity has only been slowed by some physicians’ reluctance to adopt the practice in their healthcare systems. Nevertheless, the continuous development of technology ensures the improvement of this field in the coming years. Recently, there has been a massive adoption due to a new generation of technology-focused patients and the COVID-19 pandemic that forced people to stay at home.

Difference Between Telemedicine and Telehealth

Telemedicine and Telehealth are related terms, and although they are sometimes used interchangeably by some publications and organizations, there is a difference between them. According to HealthID.org, telehealth uses electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health education, public health, and health administration.

Telehealth is a broader category that encompasses all aspects of healthcare, which includes nonclinical activities such as physical training, administrative meetings, and continuing medical education (CME). It only refers to remote clinical services such as diagnosis and treatment, while telehealth includes all the technologies that help make healthcare services better and improve delivery. So telemedicine is a category under telehealth services as it has a more significant scope.

How It Works?

Telemedicine services are conducted in several ways depending on the health institution and needs of the patient.

Video Calls: This is the primary and most commonly-used telemedical medium between a physician and patient. It’s like a typical video call between friends. In most countries, HIPPA regulations ensure all video calls are through secure video conferencing software.

Telemedicine Kits: Portable telemedicine kits that use mobile medical devices and computers like vital-signs monitors and ECGs for it’s practice. Physicians use high-quality digital cameras to send detailed images to specialists who analyze them and give appropriate diagnosis and treatment strategies.

Telemedicine Software: Institutions can use specific telemedicine software that offers a range of services involving live video conferencing and data storage. This software is continuously updated to meet up with innovations and patient needs.

How to Improve Telemedicine

For telemedicine billing services to be effective, medical institutions have to collect proper information for better service delivery. The system design should be asking pertinent questions promptly, such as pregnancy status, weight, pre-existing conditions, etc. so that they can prescribe the right treatments. Telemedicine software should be infallible if the design protocols inputted by humans are valid.

One way to improve the efficiency of telemedicine and deliver results that are the same as one-on-one encounters is to reduce documentation time by putting unstructured data into electronic health records. Also, patients could be connected faster by employing a method that connects them to the closest available physician in their time of need – similar to the Uber system. This way, an available doctor makes a call to the patient, and the patient gets a consultation.

Why Telemedicine is Important

Technology now plays a vital role in healthcare, and there is increased integration in different aspects of our everyday lives, making it more relevant than ever. With a smartphone, it’s now easier to track and monitor medical cycles while receiving therapy and treatment from the comfort of your home. In cases of infectious diseases, it also reduces the possibility of transmission, thereby increasing safety.

The American Telemedicine Association states that it can handle over 70% of urgent medical illnesses, which leads to a quick and efficient diagnosis. Many people need constant medical care but don’t have access to quality services for geographical or financial reasons. In areas of the world where quality healthcare requires travel, it helps to bridge that gap and give access to those in need.

Telemedicine Pros and Cons

This is a continually evolving concept, and while it offers a lot of benefits, it still has some challenges to overcome. Here are some of the pros and cons of Telemedicine:

Pros

Patients get easier access to specialists in their time of need. Physicians can also be referred easily without the need to worry about proximity.
It makes patient care more accessible and convenient to a lot of people.
Care schedules and appointments are easily monitored and maintained by engaging patients through telemedicine channels.
It helps save the cost of transportation and service fees for the patients. Health institutions can also save money with remote monitoring services and data storage.
Telemedicine gives physicians more time to focus on patients and provide more attention, thereby improving the quality of service.

Cons

It costs money and a lot of time to set up a proper and effective telemedicine platform. Equipment costs, training, and restructuring staff responsibilities are just some aspects to consider before building a telemedicine platform.
It is a continually changing industry, hence, it is susceptible to new laws, policies, and regulations that could negatively impact the patients or healthcare providers.

Top Telemedicine Medical Specialties

Some medical specialties easily adapted to it’s services and over the years, they have become more popular for use in telemedicine than others. They are:

Telenephrology: Nephrology practice is useful in inter-professional instances when a physician needs to consult a nephrologist about a patient’s kidney condition.

Telepsychiatry: Psychiatry does not usually require the same examination that other medical fields do. Along with a shortage of available psychiatrists, this has made telepsychiatry extremely popular.

Telerehabilitation: Rehabilitation services delivered remotely through telemedicine can give a lot of benefits to both physicians and patients.

Teleradiology: This is one of the earliest fields of telemedicine, and it allows providers to send the x-ray of a patient to a radiologist and get speedy consultation for the patient. Teleradiology is mainly used by small hospitals that don’t have an in-house radiologist round the clock.

Teledermatology: Teledermatology services work by sending a picture of a mole, rash, or other skin anomalies to a dermatologist for quick diagnosis and treatment options.

Teleoncology: Oncologists reach out to their patients through video platforms for consultations. Communication could also be through tools that allow you to forward images and get a diagnosis.

Teleophthalmology: It allows ophthalmologists to examine a patient’s eyes and treat infections from a remote location.

Telepathology: Pathologists receive images and videos for diagnosis, research, and treatment of a patient, thereby removing the need for physical interaction.

Teleobstetrics: Obstetricians can provide prenatal care without the need for physical contact by exchanging information for accurate diagnosis.

What Services Can be Provided by Telemedicine

Medical institutions can provide several health services via telemedicine depending on the area of specialization. These services include patient management, expert consultation, diagnosis, follow-up visits, doctor prescriptions, post-operation care, and therapy.

Common conditions that these services can address include:

Cellulitis
Vomiting
Bladder Infections
Allergies
Sinusitis
Sport Injuries
Insect bites

Arthritic pain
UTIs
Asthma
Bladder Infections
Bronchitis
Sprains & Strains
Colds and Flu

Sore throat
Diarrhea
Skin Inflammations
Infections
Pharyngitis
Respiratory infections
Conjunctivitis

Specialty-specific services are possible with telemedicine such as a surgeon doing a post-operation checkup or a gynecologist providing birth control counseling.

Different Types of Telemedicine

When most people try to picture of it’s in action, they see a doctor attending to a patient via video call, but it’s much broader than that. The main types of telemedicine are:

Remote Patient Monitoring

Physicians can easily monitor and track a patient’s health data and the most vital signals from different locations. If there are any warning signs, the physician will spot it and intervene accordingly.

Real-Time Telemedicine

Real-time telemedicine is the most commonly-known form of telemedicine. It involves communication through audio and video between a patient and a health care professional. It’s supposed to stand-in for an in-person visit so the physician can also deliver real-time diagnosis and support.

Store and Forward Telemedicine Communication

This is also called asynchronous telemedicine. With this, healthcare providers can send patient medical data such as images, lab results, videos, and records to healthcare personnel in another location. Data submitted on these platforms are secured so that private patient information remains confidential.

Telemedicine and Medicare

In the past, Medicare only reimbursed for some of the services provided through telemedicine under stringent conditions. With the industry’s growth, Medicare now has an expanded list of telemedicine services they reimburse. A few details to take note of in telemedicine and Medicare are:

Clearly Defined Distant and Originating Sites

Medicare provides reimbursement for telemedicine services delivered to the beneficiary (patient) from a healthcare provider called the originating site. The originating site must be a health professional shortage area authorized by law which includes:

Hospitals
Community mental health centers
Practitioners offices/physicians
CAH-based or hospital-based renal dialysis centers

Skilled nursing facilities
Critical access hospitals
Federally-qualified health centers
Rural health clinics

Eligible Providers

The healthcare providers that can use telemedicine and get reimbursements from Medicare are:

Clinical nurse specialists
Physicians
Nurse Practitioners
Nutrition professionals or Registered dieticians

Nurse Practitioners
Clinical Social workers
Physician assistants
Clinical psychologists

Facility Fees

Medicare pays the originating site a facility fee apart from the basic reimbursement. For clarity, consider a primary healthcare center that used a telemedicine visit to consult another physician in another location for a patient. They can charge a facility fee.

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Telemedicine and Medicaid

Medicaid programs depend on state laws, so they vary depending on where you are. Reimbursement policies also depend on your state. Irrespective of your current location, here are some factors that could affect your reimbursement through Medicaid:

Eligible providers (PAs, NPs)
Is a pre-existing relationship with the patient a requirement?
Suitable CPT codes
Health services included

Type of reimbursed fee (facility, transmission or both)
Location restriction on provider or patient
Is cross-state medical licensing allowed?

Future of Telemedicine

Here are some trends in telemedicine to look forward to in the coming years:

Is a pre-existing relationship with the patient a requirement?
New medical specialties will begin to adopt the telemedicine model for delivering services to patients more efficiently.
Mobile technology in it will see more advances and bring new initiatives.
Telemedicine services will become more mainstream and be addressed better in regulations at both federal and state levels.
More international collaboration with telemedicine allowing for inter-country consultation and discussion.

Telemedicine Statistics

Next, let’s look at what the facts and figures tell us about telemedicine

Patients using it’s services were 7 million in 2018 compared to about 350,000 people using it in 2013.
Up to 90% of healthcare executives say their organizations have begun developing and executing telemedicine practices.
Over 50% of hospitals in the U.S have a telemedicine program in place.
Up to 74% of patients are comfortable communicating remotely with their doctor instead of seeing them in person.
A case study of 8000 patients that used telemedicine showed no difference in care outcome between an in-person visit and virtual appointment.

Telemedicine Resource Centers

Resource centers can give useful information and research materials about telemedicine. The U.S Department of Health and Human Services’ agency, Health Resources and Services Administration (HRSA) office for the Advancement of Telehealth funds the 14 resource centers in the US.

National Telehealth Policy Resource Center

Phone: 877.707.7172
Direct: 916.285.1860

California Telehealth Resource Center

Phone: 877.590.8144

Heartland Telehealth Resource Center

Phone: 877.643.HTRC (4872)

Mid-Atlantic Telehealth Resource Center

Phone: 855.MATRC4U (628.7248)
Direct: 434.906.4960

National Telehealth Technology Assessment Resource Center

Phone: 877.885.5672
Direct: 907.729.4703

Northeast Telehealth Resource Center

Phone: 800.379.2021

Telemedicine Regulations

It’s regulations are continually changing because medical associations are always developing new guidelines for telemedicine practices to follow. Generally, the state establishes these laws, and they are as follows:

Parity laws

Only 29 states, including the District of Columbia, have passed parity laws into telemedicine, and it ensures private payers reimburse for telemedicine. Still, the particular restrictions on this payment vary by state.

Patient-Informed Consent

Patient-informed consent is received after the patient learns about the telemedicine services, and only some states require it.

Cross-state licensing

Cross-state licensing allows physicians to attend to patients not located in the state where they got their license. Some states are working to establish measures that will put this into effect.

Pre-Existing Physician-Patient Relationship

Some states make it mandatory for any patient using telemedicine to have previously paid a physical visit to the healthcare institution.

Online Prescribing

States have regulations restricting which medications physicians can prescribe online.

Barriers to Telemedicine

It can be a time-consuming process to change laws in states where parity laws don’t exist.
Staff training and equipment costs for telemedicine may not be in the institution’s budget and may strain their finances.
State-licensing requirements will not allow physicians to treat patients across the borders of their state, thereby limiting it’s capabilities.
Reimbursement policy for it is not as clearly-defined as in-person visits and is in a constant state of flux.

Who Pays for Telemedicine

Medicaid: It is usually covered and the extent depends on the laws of the state.

Medicare: Covers only it’s consultations that are through video/audio.

Patients: Most telemedicine consultations are paid for by the patients directly. Some services charge a fee per visit and others work on a yearly or monthly-based subscription.

Private Payers: There is an increasing amount of private payers paying for telemedicine, and the state usually determines the restrictions.

HIPAA and Telemedicine

All these platforms have to be HIPAA compliant and provide a high-security medium for their patient’s data. Not every video conferencing platform is appropriate for consultations. The chosen software must be safe and secure.

Telemedicine Terms

Broadband: Broadband is a communication system that can transmit different frequencies, usually as microwave, broadcast, or satellite television.

Encryption: Encoding data so only those with authorization can get access.

Clinical Information System: This is hospital-based information that has to do with patient care and not administrative data.
Video conferencing: This is the transmission of video images and audio over long distances.

Electronic health record: A collection of sensitive information about a patient’s health sent to other healthcare facilities for telemedical purposes.

Telemedicine Concerns

Patient’s inability to use the software or technology hampers the utilization of telemedicine services.
Some patients are not aware of it’s services, hence, they can’t use or benefit from it.
Continuity of care is severely affected when there is no platform integration, so a service provider might not have enough information to provide sufficient care.

Conclusion

Telemedicine can address challenges in healthcare delivery, lower costs, and improve convenience for all parties involved. Its importance is even more apparent with the prevalence of the COVID-19 pandemic where travel was restricted, leading to increased demand. In the coming years, this will undoubtedly bring about significant changes and improvements in the health sector.

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