GUIDE TO TELEHEALTH OR TELEMEDICINE
Table of Contents
How Telehealth is Transforming Healthcare
With Telehealth adoption occurring for providers of all specialty types and services. This guide will give just a glimpse of the true potential that Telehealth or Telemedicine can
The way we deliver services in healthcare is not just changing because of the introduction of computers and the internet. The era that our modern healthcare systems structured was at a time that illnesses were episodic. In other words, a patient would go to the doctor or a specialist to get “fixed.” However, the current primary challenges our healthcare system faces are around chronic and complex health conditions that require ongoing efforts for both the provider and the patient. Prevention and management are now the norms that are done by a set of clinicians of multiple specialties.
This paradigm shift in healthcare delivery and management is predominantly the driving force behind the evolution away from a fee-for-service (FFS) payment model to that of value-based payment (VBP) or capitation-based reimbursements. What that will look like in the future is entirely not clear, but it is clear the healthcare industry is moving in that direction.
Along with those transitions is the recognition that the patient is at the center of their health and needs to be an active participant in keeping themselves healthy. In other words, the clinician and patient have new roles when healthcare. The goal is no longer to go to the doctor when a patient is sick but instead taking proactive measures the help the patient from getting sick in the first place.
A Pay-for-Performance (P4P) program, for example, is generally is structured so that clinicians have financial incentives to provide evidenced-based services. For example, a pediatrician typically is reimbursed for giving their patient immunizations. However, in a P4P program, the pediatrician that delivers that same immunization according to guidelines set by “The Standards for Pediatric Immunization Practice” receives an additional payment on top of what they usually are received. The guidelines for the age a child should receive each immunization is established by the U.S. Public Health Services and endorsed by the American Academy of Pediatrics. Vigorous academic medical studies are conducted before the U.S. Public Health Services setting the standard. Hence the term “evidence-based.”
Telehealth, in recent years, has had these same types of academic studies to determine the efficacy of virtual care when compared to the traditional face-to-face visit. The results, provider-patient engagement is achieved more often and better outcomes for many areas of healthcare with the use of Telemedicine.
How Telehealth Works
Telehealth means, according to the American Medical Association, is the use of electronic information and telecommunications technologies to support a broad scope of remote health care services: Long-distance clinical care, patient and professional health-related education, public health, and health administration. Technologies can include videoconferencing, the internet, store-and-forward imaging (in which an image is saved, then sent to the other party, rather than live), streaming media, and terrestrial or wireless communications, according to the Office of the National Coordinator for Health IT.
A patient will be able to see, hear, and talk to a doctor or other health care professionals at their clinic through video conferencing, allowing the clinician to be at a medical facility, their home, or another location.
Just like with any face-to-face appointment, they can have a family member, care provider, or friend accompany if they wish.
Are Telehealth and Telemedicine the same?
What is the difference between Telehealth and Telemedicine?
Telehealth is emerging as a critical component of the healthcare crisis solution. Telemedicine holds the promise to significantly impact some of the most challenging problems of our current healthcare system: access to care, cost-effective delivery, and distribution of limited providers. Telehealth can change the current paradigm of care and allow for improved access and improved health outcomes in cost-effective ways.
Telehealth increases access to healthcare:
The Northwest Telehealth Resource Center, a non-for profit “organization that provides technical assistance in developing Telehealth networks… to serve rural and underserved communities” (Northwest Telehealth Resource Center.org, n.d.)
- Travel to distant specialists is not necessary when Telehealth is used. That means patients can save the cost of travel, the expense of staying in the ‘big city,’ if the distance is such that an overnight stay is necessary.
- The danger of traveling in winter weather is removed.
- Patients do not need to take whole days off work to see a specialist or to take their children to the doctor.
- Children miss less school when they can be seen via Telehealth
- Patients can receive care virtually thus foregoing treatment to save time and money
- Patients avoid unnecessary Emergency Costs (Average Emergency Room Visit in 2017 was $1,389) and Average Urgent Care Center Cost of $155 in 2017.
- Remote patients can more easily obtain clinical services.
- Remote hospitals can provide emergency and intensive care services.
Telehealth improves health outcomes:
- Patients diagnosed and treated earlier often have improved outcomes and less costly treatments.
- Patients with Telehealth supported ICU’s have substantially reduced mortality rates, reduced complications, and reduced hospital stays.
Telehealth reduces healthcare costs:
- Home monitoring programs can reduce high-cost hospital visits.
- High-cost patient transfers for stroke and other emergencies are avoided or reduced.
Telehealth assists in addressing shortages and misdistribution of healthcare providers:
- Specialists can serve more patients using Telehealth technologies.
- Nursing shortages addressed by using Telehealth technologies.
Telehealth supports clinical education programs:
- Rural clinicians can more easily obtain continuing education.
- Rural clinicians can more easily consult with specialists.
Telehealth improves support for patients and families:
- Patients can stay in their local communities and, when hospitalized away from home, can keep in contact with family and friends.
- Many telehealth applications empower patients to play an active role in their healthcare.
- Reducing extended travel to obtain necessary care reduces the related carbon footprint.
Telehealth improves organizational productivity:
- Employees can avoid absences from work when telehealth services are available on-site or when employees can remotely participate in consultations about family members.
- These examples illustrate where both outcomes improvement and cost savings to occur using Telehealth to deliver care.
- Home monitoring of chronic diseases such as Chronic Obstructive Pulmonary Disease (COPD) is reducing “reducing reductions in mortality ranging from 15%-56% compared to patients undergoing..normal care protocols”. For more information, look at the Telemedicine Journal Article, “Redesigning the Management of Chronic Illness.”
- The national average for re-admission to hospitals within 30 days following a heart failure episode is between 20%-25%, according to Internal Journal General Medicine 2018 April 9. Telehealth monitoring programs, as reported by the Pennsylvania Health System Study dated April 20, 2016, has reduced that level to less a relative 73% reduction.
- University of California, Irvine released a study released in 2018. The UCI study evaluated in-home rehabilitation, using Telehealth after discharge. “When examined 30 days after the end of therapy, subjects in the in-clinic group improved by 8.4 points on the Fugl-Meyer scale, which measures arm motor status and ranges from 0 to 66, with higher numbers being better.“
- Telehealth support to Intensive Care Units (often called eICUs) is reducing mortality rates by 15 – 30% and substantially reducing complications and length of stay.
Telehealth retinopathy screening programs support early identification of severe eye disease and reduce the incidence of blindness in diabetic patients.
Common Telemedicine Terms
Live video conferencing (synchronous) – the delivery of a live, interactive consultation between Primary care and specialist health services. This may involve a primary care or allied health professional providing a consultation with a patient, or a specialist assisting the primary care physician in rendering a diagnosis.
Mobile or Wearable “Smart” Devices Any device that measures or evaluates a patient health condition. Examples – Dexacom or Fit-bit is a common wearable device
Asynchronous or Remote Patient Monitoring This allows the provider to be able to monitor a patients condition remotely. A common device in use today is for diabetics. These patients wear a device (Dexacom for example) that measures their blood sugar levels real-time. Then through their smartphone device this information is reported directly to whomever the patient chooses to share it with.
Medication Reminders – automated reminders for patients to take their medication
Store and forward (asynchronous) – the use of Store and Forward transmission of diagnostic images, vital signs, and video clips along with patient data for later review that enables primary care or allied health professional is providing a consultation the ability to render a diagnosis. (example text messaging or medical chart review)
Remote patient monitoring (RPM) – including home telehealth, uses devices to remotely collect and send data to a home health agency or a remote diagnostic testing facility (RDTF) for interpretation. Such applications might include a specific vital sign, such as blood glucose or heart ECG, or a variety of indicators for homebound consumers. Such services can be used to supplement the use of visiting nurses. Synchronous or Real-Time Audio/Video
When did Telehealth or Telemedicine Start?
Telemedicine had its first start over 40 years ago by hospitals to service rural and remote areas with limited healthcare access. Even astronauts routinely have their health monitored remotely. It is not a separate medical specialty, but a way of delivering healthcare across the spectrum of medical services. However, not every office visit is amenable to Telehealth for various reasons. Nevertheless, providers that integrate their clinical delivery model with Telehealth will find they can enhance the delivery of healthcare, increase efficiency, and be available to more patients outside of their normal geographic service area.
Today, as Telemedicine is evolving, many private insurers are adopting rules to provide guidelines around how services are distributed and paid. Many insurance companies, including will now pay for a remote telemedicine healthcare visit. Providers regularly use Telehealth to visit with patients, often via call centers specifically for that purpose.
During a telemedicine consult, a healthcare provider such as a doctor, physician’s assistant, nurse, or pharmacist meets with the patient via video conferencing to provide healthcare services. This may include the transmission of still images, the use of electronic medical records, and patient portals, vital sign monitoring, health education, remote device monitoring, call center consults, and medication therapy management (MTM). The consult might take place on a computer, laptop, or even a wireless tablet. Special telemedicine software might be used in the session to gather vital data.
Healthcare Services Where Telehealth Is Effective
The types of ways that Telemedicine or Telehealth can be used is expanding every day. The Mayo Clinic, for example, has a very robust telehealth program in the Neonatal Infant Care Unit (NICU). See our blog on the development and growth of their groundbreaking NICU Telehealth program.
As mentioned earlier, healthcare is often slow to embrace new technology. However, this is not true for all sectors of healthcare. Some specialties were early adopters and, due to that, have a competitive edge. These specialties include:
- Telepsychiatry — As defined by the American Psychiatric Association, telepsychiatry is “a subset of telemedicine, can involve providing a range of services including psychiatric evaluations, therapy (individual therapy, group therapy, family therapy), patient education and medication management.” Especially for patients with severe anxiety or physical limitations, being able to consult with a psychiatrist or psychologist using telemedicine technology can prove incredibly effective.
- Teledermatology — Patients can utilize dermatology services remotely by sending a photo of a rash, mole, or other skin issues virtually, eliminating the need for an in-person visit. It is true that an in-person follow-up may be required if a biopsy is necessary but, still, time and money can be saved by using Telemedicine first. The University of Connecticut, for example, offers a full spectrum of Dermatology services via Telehealth
- Treatment for Substance Abuse A multitude of studies have shown substantial benefits in the treatment and recovery for those suffering from Substance Abuse Disorder. The Substance Abuse and Mental Health Services Administration has several articles and tools for providers to begin incorporating Telehealth into their programs
- Teleophthalmology — Through live video calling or “store-and-forward” technology (i.e., sending a picture to your ophthalmologist), patients can receive eye exams without leaving their home or office. Teleophthalmology is especially useful for diagnosing eye infections.
- Teleoncology — Offering more convenient care to patients with cancer, teleoncology makes it easier to consult with specialists who may not be easily accessible from specific locations. Photo sharing and live video calling are used in this specialty. See here for some examples of how Teleoncology is in use today.
- Tele-Obstetrics — Pregnant? Not only can the patient go to urgent care for pregnancy-related health services, but the patient can also get prenatal care using Telemedicine. One example of this is recording the baby’s heartbeat in one place and having it reviewed by a physician in another.
- Tele-Rehabilitation -According to the American Physical Rehabilitation Association of Physical Therapists,
Telehealth will not replace traditional clinical care. However, it will give PTs and PTAs the flexibility to provide services in a greater capacity. Examples:
- Patients typically in clinical or hospital settings could be managed from their homes
- Quicker screening, assessment, and referrals can improve care coordination within collaborative delivery models such as accountable care organizations or patient-centered medical homes
- Telehealth can facilitate consultation between providers or in clinical education
- Patients who need Telehealth physical therapy can receive video consultations instead of heading into an office.
One of the most promising uses of Telemedicine across all medical specialties is the ability to consult with specialists you — or your physician — may not have had access to otherwise
What are common conditions treated via Telemedicine?
Now that you better understand some of the ways healthcare is utilizing Telemedicine, let’s take a look at some specific medical conditions you can have analyzed and diagnosed via virtual appointment:
Telemedicine can also be used to review lab or test results, ask your doctor questions that came up after an in-person visit, or follow-up on treatments and prescriptions
Telehealth - Pros & Cons
There are many advantages to Telemedicine, but nothing is perfect; there are some drawbacks to utilizing technology over traditional healthcare. However, as cons to using Telemedicine are observed, solutions are being created.
Pros of Telemedicine Technology
- More accessible care for patients — Particularly patients who live in more rural areas, accessibility to healthcare can be a big issue. Telemedicine relieves this problem, allowing patients to be treated by high-quality physicians located outside of their natural area.
- More convenient care — If patients hate driving to the doctor and sitting in waiting rooms, Telemedicine is the solution. Instead of waiting, you just log on to the app or website at a scheduled time. While urgent care is incredibly convenient, especially compared to the ER or your regular doctor’s office, Telemedicine takes it to a new level.
- More affordable care — Healthcare costs are on everyone’s mind these days. With rising deductibles and more out-of-pocket payment responsibility, many patients avoid care that they need when they cannot afford to pay. Especially as Telemedicine becomes the norm rather than the exception, it also becomes more affordable. Since telemedicine visits require a reduction of resources, patients can expect to pay less than they would for an in-office visit.
- Increased access to specialists — Where you may have had to drive to another state for a specialist in the past, Telemedicine allows you access without even getting out of bed.
- Higher quality care for every patient — Doctors have long been trying to provide high-quality care to each of their patients, which is not an easy task when you’re overworked and do not have enough resources to go around. Telemedicine eliminates some of this burden, meaning you get more time with your doctor.
Cons of Telemedicine Technology
- Fewer in-person consultations — While this is also considered a positive, some patients and physicians find that in-person visits allow for a deeper level of connection and rapport to be built.
- Poor internet connection could prevent care — Unfortunately, Telemedicine does rely on a strong internet connection on both ends. If either the patient or provider is experiencing a lack of connectivity, call quality will be affected, and the care needed may not be provided.
- Reduced care continuity — This is especially an issue when it comes to mental health telemedicine services. Some apps allow patients to chat anonymously with psychologists and therapists, which prevents follow-up. If a person is at high risk for mental health conditions, this could create serious issues.
- Technical training and equipment — Of course, providers will have to be trained in using telemedicine technology. Patients, too, may run into some trouble getting set up to effectively and efficiently use telemedicine tools.
How can Telehealth services be integrated into the delivery of healthcare?
The beauty of Telemedicine is that it is available almost all the time. Whether a patient can’t get away from their office or they are traveling and need to speak with their provider, Telemedicine affords them access from anywhere there is an internet connection. Some great times to use telemedicine services include (but aren’t limited to):
- When you’re on vacation
- If your doctor’s office is closed
- If you aren’t sure whether you should go to urgent care or wait until your doctor’s office reopens
- If you have kids at home and don’t want to take them all to the doctor
- If you need a prescription refill
- If you want to hear your lab results
- If you can’t afford to take time off work
- If you want to save money on healthcare
Nearly any service a patient can get at urgent care, they can also receive through Telemedicine — and then some. Obviously, physical treatment will need to be done in-person. Still, Telemedicine is an excellent option for receiving a diagnosis before coming in, potentially saving them a trip.
Also, studies have shown that the growth of telehealth options is starting to be taken advantage of by patients. Many patients are seeing the ease of accessing a provider at a time and setting of their choice to be very appealing and are starting to look at Telemedicine as an alternative to a traditional office visit. This means that providers could be at risk of losing their patients without offering them the convenience of Telemedicine. See our article on this new transition for patients to virtual care. Providers without Telehealth at risk of losing their patients
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