What is telemedicine?

Telemedicine Today

Telemedicine

Modern telemedicine is in the status of constant advancement and change, with exponential change especially affecting coverage of patients with telecommunication pathways and ease of access to telemedicine services. The most notable advancement over last several years was the incredible increase in accessibility and affordability of telemedicine-enabled end-user devices such as smartphones and tablets that enable everyone to effortlessly start reaping benefits from various forms of telemedicine services. For example, not only is the video teleconferencing envisioned in the old 1920s concepts become a reality, but the majority of the United States population has already started interacting with the various online video conferencing apps such as Skype, Facetime and others using handheld mobile devices or home or portable PCs.

While the telemedicine was originally created to provide medical care to the patients who lived in remote areas that are far away from medical centers or medical professionals, modern telemedicine has evolved well beyond that. Support for patients in remote areas is is still ongoing, but telemedicine is not fully supporting anyone who can experience a benefit from remote medical care. This means that telemedicine has become a useful tool that evolves to the needs of the modern society and is taking advantage of all new technologies for reaching more patients or establishing a more streamlined connection with patients. Today’s patients who take advantage from telemedicine don’t have to waste time in waiting rooms. Instead, they can get immediate care for everything but the urgent conditions.

Overburdened medical facilities (most notably primary care providers) and rising expectations of more convenient telemedicine services have fueled the birth of many new telemedicine companies who are focused on 24/7 access to medical care, availability of on-call doctors contracted by those companies, and many other healthcare services. Some telemedicine companies offer access to larger health centers and hospitals, specialists or extra clinical staff, and services that enable the patient to outsource their medical questions to the wide variety of specialists that are located all around the world. Other companies are however focused on establishing better doctor-patient connections via streamlined telemedicine platforms that offer virtual visits and regular patient monitoring. More and more, telemedicine has become a tool that enables healthcare providers to offer better services that will keep them on the edge of a very competitive healthcare landscape.

 

Telemedicine has in the last several years had a big impact on the advancement of the mobile health field. A wide variety of mobile health apps, new portable medical devices and consumer-friendly services have enabled patients to much more easily keep track on their health. Patients can monitor their vital signs at home, diagnose infections, monitor glucose levels, measure blood pressure, and prepare all medical information for remote examination by doctors, who can then offer their diagnosis completely remotely. Modern telemedicine offers patients to get care much more easily and conveniently, which means that many with are receiving much higher levels of care than before when they were forced to physically visit their doctors.

 

Differences between Telemedicine and Telehealth

As years go by and technology advancements in the fields of mobile health, digital health services, health IT, communication services and mobile hardware become greater and greater, it becomes harder to distinguish differences between telemedicine and telehealth. This becomes even harder when the medical personal and healthcare industry organizations often mix those terms, making them interchangeable. However, this is not very much surprising since both telehealth and telemedicine fields use very similar service to establish remote contact with end users, including e-health patient monitoring, medical education, health wireless applications, patient consultation via video conferencing or other communication methods, transmission of medical reports, and many others.

To be precise, telehealth is a broad term that covers all health services that can be achieved using telecommunication technologies.

On the other hand, telemedicine is a subset of telehealth that is focused solely on clinical services between doctors and patients, often involving sharing of confidential (and therefore encrypted) medical data between them. Telehealth may include the use of general health services such as public health services and health education, while telemedicine involves clinician providing some kind of medical service that is aimed strictly to provide benefit to a patient. As telehealth and telemedicine continue to expand and change, patients may gain access to many more types services that are not available today.

California Telehealth Resource Center defines telehealth as “Telehealth is a collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technologies.”

 

Examples of telehealth services may be:

  • Medical education provided via video conferencing
  • Health app that informs the public about active disease outbreak

 

Examples of telemedicine services may be:

  • Mobile app that enables patient to contact doctor for a consultation via video chat
  • Software service that enables primary care provider to share patients medical images to the specialist for the purpose of consultation

 

Telemedicine Pros and Cons

 

For most patients and healthcare providers, telemedicine is a beneficiary set of services and technologies that expand the quality of patient care. It is especially useful for the patients who live in remote locations where patient care is limited. It also provides access to cheaper medical care and faster communication between patients and healthcare professionals. It also has the potential to even more enhance healthcare delivery and provide better healthcare.

 

Telemedicine also has several downsides. The biggest barrier comes from the way we perform social interactions, which can be hampered by virtual interactions or technological limitations. However, the good news is, that with each passing year the population of the Earth becomes more and more acceptable of the modern technologies and the communication methods they enable. Many believe that current issues of telemedicine will resolve themselves by both the changes in the technology and the rise of the acceptance of telemedicine. Researchers strive to create new ways to interact remotely and to improve telemedicine to the state where it will become not only a viable alternative to physical medicine but also an advantageous form of healthcare delivery in many medical situations.

 

Pros of Telemedicine

  • Convenient and accessible care – Some of the most compelling things about telemedicine is its accessibility and convenience. Originally developed to provide healthcare in areas with little coverage, this new form of healthcare delivery is now used all around the world to provide anything from basic healthcare services to the regular health checks for people who don’t have access (or funds) to regular health professionals. Telemedicine is very convenient to elderly patients who have reduced mobility, or patients in third world countries whose healthcare facilities are strained to provide care to all patients. All in all, telemedicine is a new way of providing healthcare that is not dependent on borders and physical locations.
  • Reduced healthcare costs – Telemedicine does not only reduces the cost of healthcare to the patients, but a strong telemedicine foundations can also reduce the strain of medical funding on a government level. The United States alone spends over $2.9 trillion on healthcare every year, more than any other nation in the world, and that number includes over $200 billion in unnecessary and avoidable spending. The rise of various telemedicine services has the potential to significantly reduce those avoidable funding costs by offering patients way to get quicker medic care, reducing problems, reduce ER visits, and making doctor’s time at their work much more efficient.
  • An easy way to get consultations from specialists – With usual medical care, patients can gain access to specialists only after completing complicated procedures and sometimes enduring long wait times. But with telemedicine, your doctor can much more easily get the consultation from various medical specialists, share with them your medical data, and receive their consultations all without anyone being forced to physically visit each other. For example, a patient can get access to a specialist who has focused their career on a specific form of cancer, no matter where that specialist is located. This feature telemedicine is also very useful to smaller medical centers that don’t have access to many specialists or staff that can properly evaluate all of the patient’s medical data.
  • Increased doctor-patient engagement – in today’s modern world, patients are more and more expecting regular and constant care experience. While traditional medical care enables that only when the patient is physically visiting the doctor, telemedicine can be a complete opposite of that. Telemedicine actively engages patients by allowing them to more precisely control when and how they can contact their doctors, in the way that is very convenient to both parties. This enables much more detailed medical care, more answers to patients questions, the building of stronger doctor-patient relationships, and the creation of feeling that patient has much more power in managing their health care.
  • Better quality patient care – Telemedicine enables doctors to easily follow the state of treatments that they prescribed to their patients, schedule and perform follow-up meetings, and in some cases monitor in real time health state of their patients. Access to fast information sharing and video conferencing often leads to better health results.

 

Cons of Telemedicine

  • Requires technical training and equipment – To best use everything that various telemedicine systems have to offer, some training and access to hardware are required. The amount of such training and funds needed for device purchasing can vary widely and are dependent on the specific solution that needs to offered to end-users. For example, use of emails usually does not require much training, but more complicated telemedicine systems that involve sharing of medical records between patients, doctors, and consulting specialist may require some training for both users and medical personnel. Users also need to get informed with medical devices are best suited for their needs, and their use may require some training. For example, to establish a secure video connection with a doctor, the patient needs an access to a webcam (which can be integrated into their home computing devices already, or purchasable as a standalone web camera) and knowledge how to use secure video chat app like eVisit.
  • Possible reduced care continuity – The best possible health care is established when the patient can build a relationship with their doctor, who follows their medical health and medical history over a longer period of time. However, some telemedicine providers enable patients to only request remote medical care via video conference appointments, without the possibility to pick which doctor will answer their call. This can lead to the breakdown in the care continuity, with doctors who will have to learn from scratch about your medical health state and medical history. The best telemedicine services enable doctors and patients to form long term relationships.
  • Reduction of in-person interactions with doctors – One of the possible downsides of telemedicine is that interactions established by the video conferencing (and other) methods are impersonal. While more and more patients seek to find the good provider of telemedicine services, an in-person visit to the doctor can clearly be very valuable. For example, telemedicine cannot help when doctors need to perform full physical exams. Because of this, many believe that in-person visits should be maintained and that telemedicine should be used as a supplement that can enable doctors to better follow health state of the patient. Of course, many minor acute health conditions can be addressed via telemedicine consultation, which can significantly speed up time of recovery, save money and relieve capacity of patients at the health care clinics.
  • Reimbursements and changes in healthcare policy – Patients can experience difficulties while trying to navigate changes in healthcare policies or reimbursement systems offered by their medical care providers. Reimbursements are governed by constant changes in state policies. To best get informed about what kind of reimbursements you can get for your medical care, you will need to contact your top payers and ask for their policies, check out guides to the telemedicine reimbursements, or get informed from places like this. While you will most likely be able to get reimbursements for most of your fees, it is important to note that many doctors who use telemedicine will often charge their patients with a convenience fee that can range from $35 to $125 per each remote visit. This is a payment that is most often not covered by the reimbursements, but patients are often very willing to pay such a fee to gain access to the convenience of telemedicine health services such as video conferencing.

 

Top Telemedicine Medical Specialties

Which each passing year, telemedicine becomes more and more present throughout many different medical fields, as well as ambulatory and hospital settings. Telemedicine can today be found in almost every medical field where doctors, patients, and consultants can establish remote connection one with another. This kind of medical care approach is especially needed in areas where traditional medical care cannot cover all patients with equal care, or in rural areas where patients have a hard time reaching medical care.

While some fields of medicine became early adopters of telemedicine services, several of the late adopters have pushed the development of the solutions that were purpose built to fit their needs, thus expanding the capabilities of the entire telemedicine field.

 

Here you can learn more about some of the most popular telemedicine solution specialties:

  • Teleradiology – One of the first use cases of telemedicine was for the medical field of teleradiology, with a solution that enabled doctors to more easily share and diagnose x-ray images. This enabled smaller hospitals without specialists or during off hours to broadcast x-ray images to larger medical centers that had the present staff of specialist that could transmit back their consultations. The same solution that was used then in the 1960s are also active today, but of course in much more advanced forms that allow specialists to very quickly and easily provide their opinion on the shared x-ray images and other medical data.
  • Telepsychiatry – This type of telemedicine allows patients in need of behavioral health services to easily get treatment from qualified psychiatrists. This makes it one of the most popular types of telemedicine. This is partly because of the nation-wide shortages of available qualified psychiatrists, but also because the majority of the treatments that are offered by psychiatrists does not require in-person visits.
  • Teledermatology – Since skin diseases are very common in the general population, it is not strange to find out that teledermatology has managed to become very popular. The majority of use case scenarios of this type of telemedicine involve using of store-and-forward technologies that enable the healthcare provider to manage and send photos of patients skin anomalies for diagnosis or additional consultations by skin specialists. Primary care practitioners are very used to treat various skin conditions, and thus they can provide a valuable service to telemedicine patients by quick diagnosis and reducing the need for them to travel to health care clinics. Teledermatology also allows doctors to remain in contact with their patients during their treatment.
  • Teleopthamology – With this telemedicine service, opthamologists can get the chance to examine patients’ eyes and perform follow-up check-ins during active treatments from remote locations. Eye infections are most common health conditions that opthamologists can diagnose and treat via telemedicine services such as video conferencing. Nephrology
  • Telenephrology – Nephrology (a study of the normal kidney function and kidney problems) can also be done via telemedicine services. Specialists in this field of medical study are rarely conducting direct sessions with patients, and are most often contacted by other doctors who need to consultation regarding specific patients’ medical records.
  • Teleobstetrics – Obstetricians can also provide remote prenatal care from the remote location. For example, parents can record baby’s heartbeat from their home and send via the internet that recording to obstetrician who can determine baby’s health via his local or test at remote medical facilities.
  • Teleoncology – Types of available medical care for cancer patients grow with each passing year, including advances in the field of teleoncology that offers to provide more convenient and easily accessible cafe for cancer patients. Teleoncology services include both live video platforms that allow patients and doctors to consult with the oncologist and store-and-forward tools that doctors can use to share patient’s medical data with cancer specialists.
  • Telepathology – Telepathology enable pathologists to share data at distances between themselves for the purposes of education, research and diagnosis. Most of the telepathology services are focused on providing streamlined store-and-forward solutions for sharing and forwarding high-resolution videos and images.
  • Telerehabilitation – Widely used to provide remote rehabilitation services to patients who are suffering various post-treatment conditions.

 

Services That Can be Provided by Telemedicine

 

Telemedicine is today used in almost every field of medicine. Here is only a short list of the common health conditions that primary care doctors can treat via telemedicine services:

  • Asthma and Allergies
  • Arthritic Pain
  • Bronchitis
  • Colds and Flu
  • Diarrhea and Vomiting
  • Infections
  • Insect Bites
  • Pharyngitis
  • Conjunctivitis
  • Rashes
  • Respiratory Infections
  • Sinusitis
  • Skin Inflammations
  • Cellulitis
  • Sore Throats
  • Sprains & Strains
  • Bladder Infections
  • UTIs
  • Various Sports Injuries

 

Doctors will have to decide for themselves what is the best use case scenario for using telemedicine services. He will weigh in how telemedicine can enhance the process of diagnosis, treatment and period of post-recovery. The examples of that are surgeon making sure that patient’s wounds are not showing signs of infection in the postoperative period, an endocrinologist may have one or several live video chat sessions to discuss recent lab result findings, a gynecologist may use live video chat to provide counseling and answer questions, and more.

 

Telemedicine Connection Types

You are probably now well informed about the basis of telemedicine, but what still has to be detailed is the ways these services can actually be delivered. More precisely, what kind of technologies are needed to establish digital connections between patients in their home and providers that are based in a remote location.

Expansion of Internet technologies has enabled telemedicine to become much more sophisticated and easier to use than in early decades when only telephone, radio and TV signals could be used. Today, all that is needed to establish telemedicine connection is an internet connection. This enables even patients in remote areas to participate in many forms of telemedicine.

Telemedicine can be established with the following types of connections:

  • Networked Programs – Beefy internet connections are the preferred way of connecting remote health clinics to the larger health facilities that are located in the metropolitan areas. According to the to the report from the ATA, around 200 networked telemedicine connections of this type are used in the United States. They provide telemedicine access to more than 3000 rural health clinics.
  • Point–to-point Connections – Point–to-point Connection is a dedicated high-speed internet link that connects one small remote health clinic center usually to a single large central medical center. This type of connection is often used for small and understaffed health clinics who want to gain access to the services of various specialist that are located in distant areas. The most common telemedicine services that are used via point-to-point connections are telepsychiatry, teleradiology, and urgent care services.
  • Monitoring Center Links – This type of telemedicine link is used in only one use case scenario – to establish a connection between remote monitoring facility that offers remote patient monitoring service and the houses of the patients. Patient’s data is monitored via wearable devices, and that data is funneled via the internet connection to central servers where sophisticated systems can alert doctors in the case of the appearance of data spikes (for example suddenly elevated heart rate). This data can not only be sent via the internet, but also via SMS or telephone connections. Most common use of monitoring center links is for patients with pulmonary, cardiac and old age health issues.

 

Telemedicine Types

When patients who to learn for the first time about telemedicine think about this type of healthcare service, they often envision doctor talking to the patient via video chat application. This is not strange, since two-way video conferencing is the most popular alternative to the in-person visits, enabling doctors and patients to establish a meaningful contact even though they are located in two different locations. The second thing that many think of is real-time patient monitoring via devices that beam medical data gathered from patients home directly to health care provider.

However, telemedicine covers much larger specter of healthcare services than common real-time medical consultations over video link connection, including many more clinical services that travel via all available types of telecommunications technologies.

Here is the list of all main types of telemedicine:

 

Store-and-Forward Telemedicine Solutions (also known as asynchronous telemedicine) – This type of telemedicine enables healthcare providers to gain access to patients medical data that is stored in healthcare secure servers (records, lab results, images, and videos) and share that medical data with other medical providers located at a different location. This kind of sharing is done only if the data is encrypted, no matter if the sharing is done via sophisticated internet database services or via email sharing.

Store-and-forward solutions are often called asynchronous because the sharing does not require a real-time connection between primary and secondary health provider is not needed. Communication can be established whenever the health providers get free time to process the request and offer their opinion. The easiest way to think about this approach is to envision differences between phone call (which is done in real-time) and email communication (which is not).

This type of telemedicine is most often used in for interprofessional medical services, or more precisely when patients’ primary health provider requires an opinion or diagnoses from a specialist that works in a remote location. For example, teleradiology very heavily relies on store-and-forward technologies that allow healthcare providers at smaller hospitals to share patient’s x-rays so that seasoned specialists from remote locations can offer their diagnosis. The store-and-forward approach is also commonly used in the medical fields of teleophthalmology and teledermatology.

Advantages of Store-and-forward services are numerous. With it patients are not required to personally carry their medical data to various specialists, sharing process is instantaneous, accurate diagnosis can be received much faster, and smaller health care clinics can gain access to all types of specialists that can be located at distant locations. In total, patients who reap benefits of store-and-forward telemedicine services can expect less of waiting time, more accessible healthcare, better optimization of doctor’s time and better patient outcomes.

 

Remote Patient Monitoring – Healthcare providers who want to track patients vital signs from distance need to take advantage numerous solutions from the telemedicine field of remote patient monitoring (RPM). It is also known under names telehealth and telemonitoring. As an example, healthcare providers may elect to take advantage of RPM services for monitoring patient who is recovering from surgery at home, because it offers the best way of receiving health updates that may require quick interventions.

Use of remote patient monitoring services received a big increase in popularity when health care providers came to the realization that patients suffering many chronic diseases can receive better health care and live better lifestyles at their homes, as long as doctors can retain direct access to their vital signs data that is delivered to them in daily bursts by telemedicine devices and services. Real-time monitoring is also possible.

RPM solutions enable patients to remain in close and convenient contact, which is especially important for doctors who can monitor changes in patient’s health status with great accuracy. The majority of the RPM solutions are automatically recording and collating data into daily reports, that are then distributed to the primary health provider. Sometimes, these reports may also be transmitted to the group of RPM professionals who are overseeing received data and are responsible for flagging any suspicious or clearly important data, so that doctors may have an easier time understanding patient’s health status.

RPM services depend fully on the presence of accurately used devices that have to present in users homes. These devices become smaller and smaller with each passing year, with their advance being fueled by the constant miniaturization and the popularization of smartphones, wearables and mobile medical devices. RPM can enable patient to get access to better, cheaper and more accessible healthcare, and all that is possible with the use of devices that can monitor their health signs and send that medical data to health care providers.

 

Real-Time Telemedicine – This is the most popular type of telemedicine, with its services becoming more and more present with each passing year. It is also known under the name synchronous telemedicine. The primary goal of real-time telemedicine is to enable alternative to in-person visits between patients and doctors.

Real-time telemedicine involves a live interaction between patient and his health care provider (professional medical worker, doctor, specialists or others) using audio and video communication. The most common form of real-time communication today in telemedicine is via video chat applications. While telehealth video chat services can be done via public chat applications such as Skype and Facetime, telemedicine requires the use of specially-built applications that are fully supporting encryption that can safeguard the privacy of the patient.

The popularity of real-time telemedicine grows with each passing year, with new technologies enabling patients to more easily take advantage of this form of communication with healthcare providers from anywhere, and receive an immediate diagnosis, treatment, and advice. As mobile computing devices become more and more affordable and capable, more people can establish this type of connection with their doctors. Benefits of real-time telemedicine are numerous, including added convenience of not being forced to visit doctors in-person, boosting work-life balance, faster diagnosis, improved treatment outcomes, and many others. To establish a video link with a doctor, all that patient needs to have is a computing device (desktop PC, laptop smartphone or tablet), webcam and microphone, which makes the entry point to real-time telemedicine very affordable for many.

 

Telemedicine Clinical Guidelines

The telemedicine industry is still growing and evolving, which means that many standards for governing telemedicine have not yet been finalized or approved by government agencies. In the meantime, American Telemedicine Association (ATA) has created a set of guidelines that cover a range of telemedicine specialties based on findings taken from hundreds of research studies. These guidelines can answer the questions such as – what are minimal requirements for use of telemedicine in certain states? What are best practices for use of many types of telemedicine services? What administrative, technical and clinical guidelines have to be met by medical practices need to be adopted when building their telemedicine offerings?

AMA has tried to find answers by performing over 600 studies. The result of that work is a comprehensive set of guidelines that can be used by professional hosts of telemedicine services in both primary and urgent care. Here are some of the most basic rules and protocols that have to be used by primary health care and urgent care providers when building their own telemedicine programs.

 

When to use telemedicine

Providing better healthcare services and lowering costs of diagnosis and treatments can be achieved with many health conditions, but the following ones are especially suitable to be addressed via telemedicine services – allergies, asthma, conjunctivitis, chronic bronchitis, low back pain, UTIs, rashes, otitis media, diabetes, upper respiratory infections, mental illness, behavioral health, prevention and various wellness services.

It is very important to notice that telemedicine should not be used when the patient is experiencing strong symptoms that require an in-person visit to the doctor. Healthcare providers should use their professional judgment to decide if the patient is suitable to be treated via telemedicine or it must immediately reach the nearest doctor.

 

During a medical emergency, patients should always call 911 or go to ER.

 

When to prescribe drugs

Prescribing is acceptable during video chat sessions between patient and doctors since such form of interactions can substitute in-person visits during treatment of some health conditions. Prescribing can also be done via telephone, but only if the doctor and the patient have a pre-existing relationship from previous in-person visits.

 

Informing the patient

Not all states require telemedicine service health care providers to get the informed consent from their patient to use telemedicine, but this is a good practice that should be used no matter if your state requires it or not. Before establishing first telemedicine session, service provider should explain to patients in very easy to understand and clear language how their specific form of telemedicine works (availability, privacy, scheduling, needed hardware or software, tutorials for software, etc), and especially mention any limits on confidentiality of the patient’s medical data, possibilities for technical failure, protocols for establishing contact, policies regarding prescription of drugs during telemedicine sessions, and coordination of care with other health professionals and specialist.

 

Setting up the right space for telemedicine visits

Certain conditions are crucial in conveying a professional feel during video chat sessions. Healthcare providers should strive to provide dedicated space for telemedicine visits. These spaces should ensure privacy, proper lighting, and have a good audio environment. Additionally, the camera should be placed on a stand in the height of eye level of a doctor, and no interruptions must happen during active video chat sessions.

 

Create contingency plans for emergencies and referrals

Health care providers should create contingency plans that should be communicated to the patients before their visits. This includes prepared information about referrals and request transfers to other doctors or professionals that the patient has not met before and healthcare providers that offer similar telemedicine services.

 

Patient Management and Evaluation

One of the most basic rules of telemedicine use is that relations between doctor and patient have to be done using language that patient can easily understand. If the patient is having issues with a language barrier, telemedicine should not be used and in-person visits should be recommended.

Healthcare providers are responsible for using their professional judgment in determining what types of telemedicine services are appropriate for use with chosen patients. If no service is deemed appropriate, then none should be used. Evaluation of the patient should always be based on the patient’s medical history and not just facts that are collected during the first meeting. Doctors should always strive to access as many medical records as possible.

Providers should create and follow the following clinical protocols that should be used when establishing their telemedicine services. The basic list of these guidelines should include:

  • Condition to be treated (with ICD code)
  • Scope of that condition that can be treated using telemedicine
  • Guidelines required to diagnose a condition (whether or not telephone or live video are sufficient)
  • Documentation needed to fully assess the patient’s health condition
  • Parameters that decide when the condition can be treated or cannot be treated
  • Guidelines for when prescription can be issued via telemedicine services (like live video chat session)

Health providers should use this basic lists and greatly expand it with more precise protocols for each condition they are intending to treat using telemedicine services.

 

Quality Assurance

Health providers should monitor and regularly check all of their offered telemedicine services, and try to identify all of the potential risks and failures. Examples of that include things like reliability of equipment, quality of connectivity status for video chats, complaints provided by patients or providers and more.

 

Billing

Whenever possible, patients should be informed by the provider of all the possible costs.

 

Differences between standards in in-person and telemedicine services

In general, the same standards of high-quality patient care should be used no matter if patients are using in-person or telemedicine ways of seeking better health condition. Providers should practice identical code of ethics, complying with same security HIPAA guidelines, provide proper documentation to the patient’s primary care provider, follow credential and licensing guidelines and more. More details on guidelines for practicing telemedicine can be found on the ATA website.

 

Telemedicine and Medicare

Initially, medicare required from telemedicine providers strict requirements that would enable them to receive reimbursements for the only very specific set of health services.But in the last several years, the rapid growth of the telemedicine industry has forced Medicare to expand its list of reimbursable telemedicine services. However, many of its strict restrictions on those services are still required.

 

Here is the most basic list of things that you should know about telemedicine and medicare:

Defining the Originating and Distant Sites – Medicare can reimburse telehealth services offered by healthcare providers at a Distant Site, to the patient’s (Medicare beneficiary) at an Originating Site. To receive reimbursement, patients must be located in a Health Professional Shortage Area (HPSA). The current law allows the originating sites to be only at the following places:

  • Hospitals
  • Physicians or practitioner offices
  • Rural Health Clinics
  • Skilled Nursing Facilities (SNF)
  • Critical Access Hospitals (CAH)
  • Federally Qualified Health Centers
  • Hospital-based or CAH-based Renal Dialysis Centers
  • Community Mental Health Centers (CMHC)
  • (Renal Dialysis Facilities are NOT eligible to be originating sites)

 

The patient must be in HPSA – Patients have to be located at a certified Health Professional Shortage Area (HISPA) area in order to be eligible for Medicare reimbursement. They also have to be receiving virtual care at above-listed locations. They cannot perform telemedicine sessions from their home.

 

Facility Fees – Medicare will pay the originating site a predetermined facility fee in addition to providing a reimbursement for the telemedicine service. You can learn more about the facility fees by checking out HCPCS code Q3014. It allows for things like billing two separate things -primary care provider who from its offices contacts a remote consultant can ask for two separate reimbursements – one for use of office, and one for contacting a remote physician.

 

Eligible Providers – Medicare allows that only the following healthcare providers can use telemedicine services:

Physicians

Nurse Practitioners

Physician Assistants

Clinical nurse specialists

Clinical Psychologists

Clinical Social Workers

Nurse Midwives

Registered dietitians or nutrition professionals

 

Reimbursable types of telehealth – Medicare will only reimburse sessions with live telemedicine in which patient and physician are communication that is substituting a face-to-face in-person visit, such as real-time session through a secure video link connection.

 

Only certain CPT and HCPCS codes are eligible for telemedicine reimbursement – Medicare offers only a specific list of CPT and HCPCS codes that can be covered under supported telemedicine services. We recommend periodically checking them since this list changes on a regular basis.

 

When billing, use the GT modifier – Billing of telemedicine visits needs to include “GT” modifier, and the corresponding CPT code to indicate that the service was provided via virtual means.

 

Find out the Medicare reimbursement rates – You can use Medicare Physician Fee Schedule Lookup tool to check what reimbursements you can get based on your location.

 

Telemedicine and Medicaid

While Medicare is a publicly funded health insurance program that offers national coverage, Medicaid programs are state-run and therefore very subject to the variations in the state laws and their regular changes. Telemedicine practice and reimbursement through Medicaid is because of that very dependant on what policies are currently active in your state.

Center for Connected Health Policy has released a report that provides the quick overview of that kind of telemedicine reimbursements are possible through Medicaid across the United States:

  • 9 state Medicaid programs will cover store-and-forward telemedicine
  • 14 state Medicaid programs cover remote patient monitoring
  • 46 states Medicaid programs cover live video
  • Only 3 state Medicaid programs (AK, MN, MS) offer coverage for all three types of telemedicine
  • 26 state Medicaid programs cover a facility or transmission fee, or both.

If you want to research more about Medicaid coverage of telemedicine services in your state, we recommend taking advantage of these three reliable online sources:

  • Visit your state Medicaid agency website.
  • Visit the American Telemedicine Association which provides regular telemedicine updates and quarterly reports on the state of telemedicine across the U.S.
  • Visit The National Telehealth Policy Resource Center

 

Factors that can affect Medicaid reimbursement for Telemedicine

Since Medicaid has strong requirements that vary from state to state, and some of the requirements cannot be 100% clear during casual reading, we recommend to take the following factors into the consideration when looking up if your treatment may affect your chances of telemedicine reimbursement through Medicaid:

  • Health Services covered
  • Eligible providers (NPs, PAs)
  • Is cross-state medical licensing allowed?
  • Is a pre-existing relationship with patient required?
  • Location restrictions on patient or provider
  • Applicable CPT codes
  • Type of fee reimbursed (transmission, facility, or both)

 

Future of Telemedicine

Large advancements in technology and online services have enabled telemedicine to become much more accessible, affordable and easier to use all over the world. This trend of rapid advancement does not look like it will stop anytime soon, enabling more people to gain access to remote healthcare services over the next several years. This includes the rapid development of the following technologies:

  • The arrival of the new segments of wearable devices – smartwatches and smart glasses that can both be used for measurement and transmission of patient’s’ vital signs. Google Glass has popularized a first consumer-friendly computerized eyeglass technology, while numerous smartwatch designs and solutions from Apple (Apple Watch) and Google (Android Wear) have enabled users to always carry on themselves the large array of sensors that can monitor their health status.
  • Advancements in robot technology have started enabling doctors to perform robotic surgeries on remote patients.
  • Several startups in digital health technology have started experimenting with services that can analyze person’s emotional state based on their facial expressions.
  • New advancements that augment current telemedicine services are being tested each passing year. For example, Digital health startups like Augmedix is developing a service that can automatically transcribe documentation during a telemedicine meetings between doctors and patients.

Studies have shown that the telemedicine industry will become a 36.3 billion industry by 2020. That and the fact that currently, 75% of patients is reporting interest in telemedicine, this field of health care is bound to become even more present and influential over the next few years. However, expansion of telemedicine technology and services will have to be followed with the following changes:

  • Lowering of administrative barriers
  • Changes in telemedicine practice via state legislations
  • Lowering telemedicine requirements
  • Constant advancement of reimbursement policies

 

Telemedicine Statistics

Since the appearance of the first simple telemedicine services in the 1960s, many have claimed that this new form of health service will offer great advancement and a large array of benefits. Here is what researchers have managed to actually collect about the usefulness of telemedicine, including various statistics and interesting findings.

  • All the findings are pointing to the single fact – telemedicine has managed to grow into a very big industry that moved $17.8 billion in 2014, and all signs point that it will manage to almost double in size by the year 2020.
  • It is believed that approximately over 800 thousand virtual connections and consultations were made in the United States only in the year 2015. ATA president Dr. Reed Tuckson has said that entire health system of United States (legislators, doctors, patients and others) are starting to feel the impact of telemedicine grow.
  • Surveys have come to the conclusion that over 90% of healthcare executives are in the process of developing or implementing new telemedicine programs, and 85% of them said that those programs represent a very important investment.
  • IHS has released a statistic that shows that a number of patients using telemedicine in the United States will grow from around 350 thousand in 2013 to over 7 million in 2018.
  • High demand for telemedicine has pushed legislators to push much more bills that support and regulate this new field of health services. In August of 2016, Congress waited to deliberate on 26 telemedicine-related bills.
  • Numerous studies have shown that patients are more and more willing to use telemedicine services. NTT Data has found that 74 percent of surveyed patients in the United States were open to using various telemedicine services, most notably using video chat sessions to comfortably communicate with their doctors.
  • Additionally, 67 percent of them have expressed a feeling that telemedicine could help them receive better medical care.
  • 76% of surveyed patients from U.S. have said that easier access to healthcare is more important to them than the loss of the in-person human interaction with their doctors.
  • Only 16% of the surveyed patients also expressed the feeling that they would rather go to ER to treat minor health condition than contact doctors via telemedicine services.
  • Patients who live in the areas where health clinics are facing shortages of open patient slots and have overburdened primary care doctors have shown much higher tendency to adopt telemedicine services.
  • Research into the usefulness of telemedicine services becomes more precise with each passing year. Veterans Health Administration reported hospital readmissions of heart failure dropped by 51% after they implemented telemedicine for monitoring past heart attack patients.
  • Geisinger Health Plan reported 44 percent reduction in 30-day hospital readmissions after implementation of telemedicine.
  • Study of 8 thousand telemedicine patients has recorded no difference in the quality of care and health outcomes between in-person treatments and virtual care.
  • Several of the most important reasons why healthcare executives are keen on implementing telemedicine services are the improvement of the quality of patient care, ability to provide round-the-clock care, more convenient way to reach the larger amount of patients, and lowering of cost.
  • Studies have shown that around the half of patients who experienced telemedicine care report that they feel more involved in the treatment and have become much more engaged in managing their healthcare.
  • US employers can save around 6 billion per year on costs of healthcare by implementing telemedicine services.

 

Telehealth Resource Centers

U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) Office for the Advancement of Telehealth are currently funding 14 telehealth resource centers that offer most of their services for free. They serve as local hubs of information, places for the organization of various research projects, and places where various projects are trying to increase healthcare access for underserved communities.

A full list of the telehealth resource center can be found on their website, but here is the listing of the some of the largest ones:

 

National Telehealth Policy Resource Center

Phone: 877.707.7172

Direct: 916.285.1860

Interactive U.S. map of telehealth policy, state-by-state

They provide regular sending of news and policy updates via Twitter, Facebook, or by email

Easy access to sheets, policy briefs, and even a micro-documentary on telemedicine!

 

California Telehealth Resource Center

Phone: 877.590.8144

Best practices for developing a telemedicine program

Sample forms and guidelines to use in your telemedicine program

Training page with links to webinars, videos, and free on-site training services for California programs

 

Heartland Telehealth Resource Center

Phone: 877.643.HTRC (4872)

Useful reimbursement guides for Kansas, Missouri, and Oklahoma

Regularly updated regulation guides for Kansas, Missouri, and Oklahoma

 

Mid-Atlantic Telehealth Resource Center

Phone: 855.MATRC4U (628.7248)

Direct: 434.906.4960

State-specific resources for Virginia, West Virginia, Kentucky, Maryland, Delaware, North Carolina, Pennsylvania, Washington DC, and New Jersey

Ability to request a speaker on telemedicine

Directory to find telehealth providers in supported States

 

National Telehealth Technology Assessment Resource Center

Phone: 877.885.5672

Direct: 907.729.4703

Listing of telemedicine-friendly technologies and devices, with accompanying user-review section

Toolkits on new technologies, medical devices, and apps to use with your telemedicine program

 

NorthEast Telehealth Resource Center

Phone: 800.379.2021

Great Telehealth “A to Z” section with resources organized into categories such as clinical, financial, and technology

Telehealth toolkits for psychiatry and dermatology

 

Telemedicine Regulations

Regulations that govern telemedicine are being developed and changed with each passing year, and the constant flux of laws, guidelines, and practices are also happening on a per-state level. Organizations and medical associations such as FSMB and AMA continue to work on the development of telemedicine practice, the introduction of new legislations and more. Most U.S. states pass new telemedicine regulations on regular basis and have many more bills awaiting the decision. The number of telemedicine-related legislations is at the all time high. Most regulations are focused on regulating how telemedicine can affect reimbursements by Medicaid and private payers in that state.

Patients who want to learn more about the telemedicine regulations need to check the specific laws that are active in their state and to keep track of the possible changes to those laws.

 

Parity Laws

Parity laws have been for now passed in 29 states and the District of Columbia. Those laws require private payers to reimburse patients for telemedicine services, with specific reimbursements restrictions that are placed and can vary by the state. In the majority of cases, reimbursements offered by private payers are for the same amount as comparable in-person medical services. The presence of parity laws can also affect coverage offered by the state Medicaid program.

 

Cross-state licensing

Even though telemedicine can enable patients to remotely contact healthcare providers that are based in any territory, those providers are however licensed only to provide health services to the patients who live in the same state as they. As of now, all 49 state medical board require from physicians who practice telemedicine to serve only patients from states where they are licensed themselves.

Some states are working on passing laws that would enable cross-state licensing, which would enable several state medical boards to work together and establish new licensing agreements.

 

Patient Informed Consent

Several states require healthcare providers to get a patient’s informed consent for using telemedicine services. This consent can be provided in both written or verbal, depending on the state (or it not being needed at all). Most of the healthcare providers maintain parity with the patient informed consent practices between in-person care and telemedicine care.

 

Online Prescribing

Almost all states have precise and specific laws that govern what types of medications can be prescribed via telemedicine care and which cannot. In most states, schedule III to V drugs can be prescribed to patients online, which is not the case for schedule II drugs that have to be prescribed only during in-person visits to doctors. Those drugs are most commonly used for chronic pain management.

 

Pre-existing Physician-patient relationship

Many states require from telemedicine providers to have already established the physician-patient relationship before they can begin using telemedicine services. This usually mean that they need to have at least one in-person visit before first telemedicine video chat session can be scheduled. In states where this law is not in effect, companies like DoctoronDemand and Teladoc are offering service where patients can easily request an online session with a physician that will be assigned to them randomly.

 

Resources

Here you can get much more informed about all facets of the telemedicine legislations:

American Telemedicine Association state legislation matrix

The National Telehealth Policy Resource Center

Medicaid agency website

 

Telemedicine Barriers

Even though the telemedicine industry has grown much over the last several years, various barriers still prevent it from reaching its full potential. Here you can get informed about some of the most important barriers that are limiting its growth.

 

Legislation

State legislations are the biggest limiting factors of telemedicine, often placing strict restrictions for example on the reimbursement rates for telemedicine services that are administered in those specific states. For example, states with active Parity Law require from and private payers to reimburse the same amount for telemedicine visits as for comparable in-person visits. Another strong braking point for many telemedicine practices are the constant changes in state legislations that can cause wasting of time and waste of funds on the transition periods where telemedicine providers need to change their practices.

 

Reimbursement process

The lack of many laws has produced a landscape in which in many states getting reimbursement for telemedicine service is not as easy as getting reimbursement for the comparable traditional in-visit service. Rules and regulations around reimbursement through state Medicaid programs and through private payers are constantly shifting, and every change of state telemedicine policy causes healthcare providers and patients to jump through more legal hoops. For example, Medicare has finally reached a state where it can reimburse for the real-time telemedicine services, but it has placed strong restrictions on the eligible healthcare providers, the exact location of the patient, the medical procedures that can be reimbursed and many others. Many healthcare officials are striving to promote adoption of less-restricting state laws.

 

Telemedicine Implementation and Equipment costs

With each passing year, telemedicine services become more diverse, but that means that establishment of new telemedicine providers requires larger investments. They are required to purchase more and more types of equipment, train the staff to use them, and invest into other costs (such as providing dedicated offices for hosting telemedicine sessions) and more. These costs can add up to the point that the smaller healthcare providers cannot cover them with their budgets. A majority of smaller providers and independent practices are already strained by the current regulations, staff training practices and other laws that are imposed by the Meaningful Use program. The cost can also be felt on the patient side, with them needing to gain access to a webcam-equipped computing device.

 

State Licensing requirements

Telemedicine is required to follow same rules that healthcare providers have to follow when earning their medical licenses. This means that medical license for a single state enables the healthcare provider to practice health care only in that state, no matter if he is using traditional medicine or telemedicine. This reduces the potential of telemedicine to reach patients no matter where they are living.

Several telemedicine organizations are currently pushing for the adoption of the laws that would enable health providers to earn cross-state medical licenses.

 

Who Pays for Telemedicine

 

Medicare

Under certain circumstances, Medicare will pay for telemedicine services, such as live telemedicine sessions and virtual visits delivered via interactive audio and video. The reasoning for paying these services is to cover medical costs when the in-person visit would be too difficult to organize by either patient or provider. This makes healthcare more accessible. Non-live telemedicine services such as “Store-and-forward” are currently only covered in Hawaii and Alaska.

One big requirement of Medicare is that will only pay for telemedicine services when the patient is located in a Health Professional Shortage Area (HPSA), is receiving health care from an eligible and licensed provider, and that service is a part of the adopted CPT/HCPCS codes. When all these conditions are met, Medicare will then pay 80% of the physicians free and will also pay a facility fee to the licensed originating site. The patient needs to pay the remaining 20% of the fee. Convenience fee that some telemedicine providers require can not be reimbursed.

 

Medicaid

Each state has its own laws that govern what telemedicine services Medicaid can pay, and in what situation is that payment allowed. Telemedicine live video sessions with physicians will be paid in part by Medicaid in 46 states. 26 states will also pay the telemedicine facilities to cover the cost of hosting telemedicine session or to cover the cost of transmission of patients encrypted medical data.

Each state has its own set of rules that govern the relationship between Medicaid and telemedicine.

 

Private Payers

Private companies such as United Healthcare continually expand their presence in the telemedicine industry, offering payments for more and more telemedicine services, including even expanding the coverage to include 24/7 on-demand virtual visits to people enrolled in employer health plans.

The amount that private payers can pay can vary widely from state to state. For example, 29 states and Washington DC have adopted telemedicine laws that require private payers to cover costs of telemedicine services in the equal amounts as in-person visits.

 

Patients

To this day, the majority of the telemedicine visits are paid by the patients themselves. Many online services that offer 24/7 access to virtual doctor visits will charge either timed subscription access fees (monthly or yearly) or a per-visit-fee. All those payments are paid directly by the payer and are not routed through insurance. Direct-pay or concierge practice model is often used by doctors who offer virtual visits to their patients. Patients may also create a high-deductible insurance plan for emergencies, which can then me maintained via regular yearly fees that essentially enable patients to have their doctor on retainer.

Doctors also often require from patients to pay so-called “convenience fees” for each virtual visit or can offer their virtual visit service as a part of patient’s subscription for the private healthcare coverage.

 

HIPAA and Telemedicine

Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a law that governs the health insurance coverage and protection of privacy for workers and their families when they change or lose their jobs. Like all other technologies and services inside the healthcare space, all licensed telemedicine providers in the US need to comply with this set of laws. HIPAA requires from telemedicine providers to use high-level security solutions that will prevent any breaches of patients personal health data. This means that if you contact your doctor via free and publicly available video chat applications such as Facetime of Skype, those unsecured health care sessions are not covered under HIPAA act.

To be fully covered under HIPAA, not only providers technical solutions need to be compliant, but also all other applications, services and procedures by its staff, patients and patient’s computing devices. This means that every piece of software that is used in telemedicine needs to be completely optimized to be HIPAA compliant, which can introduce time-consuming and costly investments to telemedicine software vendors. National Policy Telehealth Resource Center has noted that “Compliance with the Health Insurance Portability and Accountability Act (HIPAA) is more complex than simply using products that claim to be ‘HIPAA-compliant.”

To be fully HIPAA compliant, covered entities have to use organized set of secure, documented and monitored practices within and between their operational procedures. Even though software products alone cannot ensure full compliance, some products may contain enough of the elements or featured that may allow them to be operated in an HIPAA-compliant way.

 

Telemedicine and Telehealth Terminology

Telemedicine and telehealth tindustries have grown tremendously from the first moment they appeared, bringing with themselves not only great advancements in the ways health care delivery but also many new terms that general audience needs to get acquainted with before they can fully grasp everything that these new services can provide to them. Here are some of the most commonly used terms and definitions that are used today in telemedicine and telehealth:

 

  • Application Service Provider (ASP) – Application service providers provide a space and hardware for holding various applications on their central servers. Customers can then pay a fee to access those apps and services via secure internet connections or via private networks. This means that they don’t have to buy expensive applications, install and manage them on their own, but they can rent the applications they need while ASPs will work to make sure they are always accessible and operational.
  • Asynchronous – This term is used to describe the process of storing and forwarding transmission of medical data information (such as medical images or videos) between two parties that is not done in real time. This type of data transmission is done only in one way (from a primary care provider to a specialist), and not in two-way (synchronous communication).
  • Bandwidth – A measure of the size of the carrying capacity of the communication channel. In telemedicine, a communication bandwidth can impact its capabilities, cost, and size of the telemedicine services. Email correspondence demands the least amount of bandwidth, while high-resolution video conferencing demands the most. The bandwidth requirements for the particular telemedicine service need to be met by both primary care providers, consultants, and patients.
  • Bluetooth Wireless – This refers to industry accepted communication standard for wireless communication inside short range networks. It allows a simple and straightforward way of connecting and exchanging data between devices such as mobile phones, PCs, laptops, digital cameras and printers over a short-range, secure and unlicensed radio frequencies. The developer and specification holder of this standard is Bluetooth Special Interest Groups.
  • Broadband – Communication standard that has the ability to carry a wide range of various frequencies that are being transmitted in a frequency-modulated manner. This enables several messages to be transmitted simultaneously over a portion of the total available bandwidth potential of the communication line. In the commercial space, broadband is most commonly known as “high-speed internet connection”.
  • Clinical Information System – This refers to a hospital-based information system that has been designed from the ground up for the organization and collection of data that is only concerning patient care. This system does not manage data that is connected to other administrative services of the healthcare provider.
  • CODEC (coder-decoder) – CODEC is a video-conferencing device made by external technology providers (Polycom, Tandberg, Sony, Panasonic or others) that convert video signals and analog audio into digital audio and video code and vice versa. They are most often used to compress digital code into a smaller size in order to easily be carried via internet connections of limited bandwidth.
  • Compressed video – In order to transmit video data over the limited internet connection, video images often require to be processed into a smaller size. This greatly reduced the bandwidth needed for the video file or video feed to be sent or received.
  • Computer-based Patient Record (CPR) – Electronic format for storing individual patient information. It has been designed to enable easy access to complete patients medical information.
  • Data Compression – Encoding method of reducing the size of data without introducing any significant data loss. Encoding reduces storage requirements, bandwidth requirements, image processing times and transmission times. For example, video feeds or files are often compressed before them being sending over the internet, while some medical records need to be saved in their raw (uncompressed) state so that all their data could be used for clinical diagnosis.
  • Diagnostic Equipment – Hardware devices that are not directly part of a central computer (such as cameras, scopes, digitizers and others). They are mostly used as data inputs or outputs.
  • Digital Camera – Used for taking still images of patients, most commonly by patients who have suffered a wound or have dermatology issue. Captured images are usually downloaded into the PC and then sent to the primary care provider or external consultant. Smartphones can capture and transmit images using their own built-in camera, storage and communication modules.
  • Digital Imaging and Communications in Medicine (DICOM) – An industry-accepted communication standard for medical imaging devices. It consists of the set of vendor-independent protocols, and it also describes how to identify and format captured medical images. It was originally developed and introduced by National Electronic Manufacturers Association and American College of Radiology.
  • Disease Management – A health process that in coordinated and continuous way manages and improves the health status of the specifically defined population of patients over the entire course of the disease, from its diagnosis to completed treatment. The targeted patient population are high-risk, high-cost patients that suffer from chronic conditions that often require carefully administered and appropriate care in order for treatment to be managed correctly.
  • Distance Learning – Set of audio and video technologies (with accompanying hardware) that allow students to attend training sessions or classes that are conducted from remote locations. Most of the distance learning systems support interactive communication (two-way video or audio conferencing) and are a very useful tool in providing education to the pool of students that are widely-dispersed, or when the instructor is unable to travel to where students are located. Distance learning is also regularly used by instructors who want to augment their lessons with guest-talkers who will attend the class remotely.
  • Distant Site – A telehealth or telemedicine site where primary care provider or a specialist perform consultation with the patient. This term is also known as physician site, provider site, referral site, consulting site and hub site.
  • Document Camera – A specific type of camera that is able to display documents (lab results, written reports), graphics, photographs and x-ray images.
  • Electronic Data Interchange (EDI) – The process of directly receiving and sending data between two persons without direct person-to-person contact or use of paper.
  • Electronic Patient Record – Electronic data format that contains medical information of the particular individual patient, including entire and accurate medical history, links to medical information, clinical decision support systems, alerts, reminders and other types of aids.
  • Encryption – A security system for encoding data on web pages or emails that enable only authorized computer systems or persons to access it, retrieve it and decode it into a usable form.
  • Firewall – Security software or hardware that blocks the unauthorized communication between organizations or personal computer network and external networks.
  • Full-motion Video – A type of video signal data that enables videos to be sent via large distances and reproduced in the form of the sequence of uninterrupted and smooth images.
  • Guideline – A policy statement or procedure that governs the use of actions and guidances in setting standards.
  • H.320 – The specific technical standard that governs video conferencing compression standards that can be used by various equipment that is connected to T1 or ISDN internet connections.
  • H.323 – Specific technical standard that governs video conferencing compression standards that can be used by various equipment that can use Internet Protocol.
  • H.324 – Specific technical standard that governs video conferencing compression standards that can be used by various equipment that can use Plain Old Telephone Service (POTS).
  • HL-7 – Also known as Health Level-7 Data Communications Protocol. This communication standard governs the transmission of health-related information. HL-7 enables integration of other applications and service into a unified system, such as patient accounting, order entries, hospital census, radiological imaging stations, and bedside terminals.
  • HIPAA – Acronym for Health Information Portability Act, a set of laws that, among many other things, governs portability and continuity of health insurance coverage.
  • Home Health Care And Remote Monitoring Systems – A type of traditional or telemedicine care that is provided to the patients and their families in their own residences. Its primary goal is to promote, maintain or restore health, or to minimize the effects of disabilities or illnesses. Home health care is defined by Medicare and Medicare Current Beneficiary Survey as “ home visits made by professionals, including physicians, nurses, home health aides, therapist and social workers.” The use of various monitoring devices and interactive devices enables recording and transmissions of patients vital signs (in real time or in predefined intervals) to the primary health provider without the need for patients to travel and make in-person visits in health clinics.
  • Informatics – Using computer science and information technologies to process and manage knowledge, data and information, and showcase results in a visual manner.
  • Integrated Services Digital Network (ISDN) – A type of dial-up transmission protocol that is used for video conferencing. ISDN is an on-demand service where an ISN based device has to be dialed, with per-minute charges being accumulated at the predefined contracted rate from the internet service provider. Only the site that started the call is billed. Entire service is very similar to the one of making long distance telephone calls. ISDN can support data bandwidth of 128 Kbps. ISDN does not allow high-speed internet connection as more modern broadband solutions.
  • Interactive Television/Video – Set of technologies that are very similar to video conferencing over the internet, that is instead relying on television technology to transmit video and audio. Two-way real-time (synchronous) audio/video communication is possible. It is mostly used for distance education, telemedicine or telehealth services.
  • Internet Protocol (IP) – The communication protocol for sending data between computers that are connected to the Internet. Each computer on the Internet is given a unique address that distinguishes that computer from all others. This IP address is then used as a “telephone number” for contact between distant computers. It is important to note that Internet Protocol is a connectionless form of protocol, which means that user does not need to create a new connection when trying to connect to other computers.
  • Interoperability – Ability of the two or more independent systems (communication devices, software, networks, computers and other types of information technology components) being able to communicate one with another, exchange information and enable delivery of predictable results. Interoperability is separated into three different main types – technical, clinical and human/operational.
  • ISDN Basic Rate Interface (BRI) – A type of interface that ISDN connection used. ISDN offers 128 Kbits of data bandwidth, but multiplexer can link together several BRI lines and enable the user to access much higher bandwidth speeds that are needed for services such as synchronous video conferencing. Most popular configuration is linking of three ISDN lines into a single connection with 384 Kbps of bandwidth. Users need to check with their internet service providers whether or not they support BRI service of linking multiple ISDN lines.
  • ISDN Primary Rate Interface (PRI) – A type of ISDN interface that uses one 64 Kbps data channel and a multiplexing equipment that can add additional 64 Kbps data channels (up to 23 of them) depending on the needs of the user. For example, if the user needs 384K bandwidth for video conferencing, the multiplexer can use six channels to achieve needed speed. User pays the internet service provider based on the length of the connection and a number of channels that were in use.
  • JCAHO – Acronym for Joint Commission on Accreditation of Healthcare Organizations.
  • Lossless – Raw data format that does not uses any form of compression that has reduced its data size or presence of information (like reduced image quality). The only supported compression type is image color compression which can lead to 2:1 compression ratio. Lossless data can be reproduced without any data loss.
  • Lossy – Lossy data is data that was compressed with very high data compression ratio. This process most often discards unneeded information and compresses what remains.
  • Nursing Call Center – Centralized office for nurses that support their daily workloads, such as answering telephone calls from patients, responding to faxes, electronic mails and letters, access medical databases with patient basic health information. Nursing call centers are not allowed to share confidential patient medical data, patient diagnosis or prescribe medications.
  • Mobile Telehealth Clinic – Mobile vehicles such as van, trailer or others (in some rare cases even large ships) that are filled with equipment and personnel that can provide health care services for patients. They are very useful when serving in the areas that are not well supported by medical clinics and hospitals. Mobile clinics are staffed with healthcare professionals who often have access to mobile versions of equipment that is most commonly found in hospitals, such as MRI, CT, and TeleDentistry. They take full advantage of wireless telecommunication systems to access telehealth and telemedicine services that can provide benefit to their patients.
  • Multiplexer (MUX) – Device that combines several digital inputs into a single output data line. They are mostly used for combining several ISDN channels into a singular data carrier stream.
  • Multi-point Control Unit (MCU) – A device (also known as a bridge) that can connect several video conferencing sites into a single system.
  • Multi-point Teleconferencing – A process of connecting several users from different sites into a single video conferencing session. In addition to creating a unified audio/video teleconference stream, it also allows more streamlined sharing of data between connected computers and network servers. This process is achieved by using a multi-point control unit or the bridge.
  • Network Integrators – Organizations or personnel groups that provide services and develop software that allow streamlined sharing of data, voice, video and communication between different internet-connected devices and systems.
  • Originating Site – A location where a patient is located during an active telemedicine session. It is also known under the names of remote site, patient site, rural site or spoke site. This location is the place where the patient can take advantage of telemedicine services, gain access to his medical data, establish a video conference link with his doctor and more, all with the help of the internet connection and a device that can establish that connection. The originating site may be person’s home or licensed health clinic facility.
  • Patient Exam Cameras – Cameras used to evaluate health condition of a patient during telemedicine sessions. They come in many shapes and forms, including handheld cameras, camcorders, gooseneck cameras and cameras that are placed anywhere around video conference set-top units. They can be both analog and digital, depending on the type of telemedicine system that is being used.
  • Peripheral Device –  Any device that can be connected to the computer and serve the role of input or output of data. They can be as common as mouse and keyboard but can be rarer such as scanners, clinic monitors, various sensors, weight scales, pulse oximeters and more.
  • Telepharmacy Solutions – Pharmacy services provided to patients via telecommunication or electronic means. They are commonly used when patients cannot personally visit pharmacies due to travel difficulties or health issues.
  • POTS – Acronym for Plain Old Telephone Service, a regular phone network.
  • Presenters or Patient Presenters – Presenters in various telehealth services, which can be both informative or involve performing exams on patients. They are often well trained in providing health services via telemedicine solutions, must be educated in the medical field they are practicing and trained to use telehealth equipment. Most often they are trained nurses, but can also be doctors who can provide an immediate diagnosis to the patients who are located remotely at the originating site.
  • Regional Health Information Organization/Health Information Exchange (RHIO/HIE) – Organizations that are focusing on monitoring and ensuring that telehealth services are delivered in a high-quality, efficient and safe manner.
  • Router – Device used to provide the data connection between at least two internet networks. Those can be networks inside a health organization or connect the home local area network and public internet. The router manages the connections and makes sure all connection requests are fulfilled in the fastest and best possible ways.
  • Standard – Benchmark used to measure the quality of the results. It is established by the authorities to make sure organizations are achieving the desired results.
  • Store and Forward – Type of telehealth and telemedicine consultations between primary care providers are sharing patient’s medical records with an external consultant that can help with the finding of correct medical diagnosis, such specialists. They are most commonly used in dermatology, radiology and wound care. The type od medical records that are most often shared are patients’ clinical data, blood test results, ECG, X-ray images and various other laboratory test results.
  • Switch – Device that is responsible for selecting the path in which the internet data will go through local and secure networks before reaching the public internet. For example, the switch may determine what path will video conference single use. Switches are very similar to routers, except it can handle much more connections.
  • Synchronous – The term that describes an interactive connection between at least two video or audio sources, with data that is traveling in real-time between all connected sites. Video chat session is synchronous service, while email correspondence or voicemail messages are not.
  • System Integration – The process of bringing two or more systems or devices into a connected state, enabling sharing of data and information between those systems.
  • T1/DS1 – Standard for sharing data over telephone lines that provide the bandwidth of 1.544 Mbps per single line.
  • T3/DS3 – Standard for sharing data over the internet connection with a bandwidth limit of up to 45 Mbps.
  • Transmission Control Protocol/Internet Protocol – A set of standardized rules for establishing and maintaining internet network connections between at least two computers or devices.
  • Telecommunications Providers – Entities authorized by the United States government to provide various telecommunication services to all residents and institutions located in the U.S.
  • Telemedicine and Telehealth – Terms that describe health services that use various telecommunication means of exchanging medical information from one place to another, with an end goal of improving patient’s health status. Telehealth is often used for public sharing of data between health professionals and the public, while Telemedicine is focused on patient clinical services that can provide professional diagnosis and treatment of the patient, this making it much more regulated by laws and standards.
  • Teleconferencing – Electronic communication between multiple users across various remote sites. It can be established by computer systems either with audio or video links. Interactions are almost always performed in real time (synchronous) and are used for direct patient-to-doctor interactions that can lead to the development of full medical diagnosis and treatment plans. Patients can use teleconferencing both from their home or from inside licenses medical facilities.
  • Telementoring – A form of teleconferencing that involves the offering of guidance. For example, it can involve seasoned healthcare professional mentoring a local healthcare provider who has just finished his basic studies.
  • Telemonitoring – Another form of teleconferencing that uses video, audio and other electronic and telecommunication systems to perform the service of real-time monitoring of patient’s health status via large distances. It is mostly used in home care.
  • Telematics – Using telecommunication technologies to allow applications to transfer data between computers, and use of information processing that is based on computer use.
  • Telepresence – Use of robotics and other technologies that allow the professional medical practitioner to perform a procedure on a remote patient, while also receiving sensory information or feedback that contributes to the building of the sense of presence. For example, a surgeon can place his hand into a mechanized glove that is not only recording his movements and transferring those exact movements over the internet to a remote site where a surgery is actually taking place, but also send back sensory feedbacks that doctor can feel wish his own hand.
  • Teleradiology – The process of transferring radiological images (such as CT, MRI and X-Ray scans) over telemedicine services for purpose of getting consultations, diagnosis or interpretations. The transfer can be achieved via all available telecommunication technologies such as the internet, local area connection, satellite links and telephone lines. Medical technology under the name “Picture Archiving and Communications Systems” allows healthcare professionals to access economical storage solution for radiological images, with built-in tools for easier sharing.
  • Universal Service Administrative Company (USAC) – This organization is responsible for administering Universal Service Funds (USF) that allows easy access to wide variety of telecommunication services across the U.S. One important sub-section under USAC is Rural Health Care Division.
  • Ultrasound Device – Device that emits and then records echoes of high-frequency sounds to examine internal body organs. They can be used to detect tumors and other internal body organs and abnormalities.
  • WiFi – A wireless communication standard licensed by the Wi-Fi Alliance that uses widely used for the creation of wireless local area networks (WLANs). It is primarily used by handheld mobile devices (such as smartphones), laptops, PCs, routers and other communication gear. Supported services include networking, data transfer, VoIP phone access, gaming and peripheral device connections.
  • Videoconferencing Systems – The set of equipment and software solutions that allow the establishment of real-time and two-way video communication between at least two locations. The data transfer is usually done via LAN or Internet connection.