Telemedicine History, Definitions and Reference

An introductory guide for those new to Telemedicine

What is Telemedicine?

“The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities.”

The many definitions highlight that telemedicine is an open and constantly evolving science, as it incorporates new advancements in technology and responds and adapts to the changing health needs and contexts of societies.

Some distinguish telemedicine from Telehealth with the former restricted to service delivery by physicians only, and the latter signifying services provided by health professionals in general, including nurses, pharmacists, and others. However, for the purpose of this report, telemedicine and Telehealth are synonymous and used interchangeably.

Origins of Telemedicine

What is Telehealth, What is telemedicine

Historically, telemedicine can be traced back to the mid to late to earliest days of the telephone when electrocardiograph data were transmitted over telephone wires. Telemedicine, in its modern form, started in the 1960s in large part driven by the military and space technology sectors, as well as a few individuals using readily available commercial equipment. Examples of early technological milestones in telemedicine include the use of television to facilitate consultations between specialists at a psychiatric institute and general practitioners at a state mental hospital, and the provision of expert medical advice from a major teaching hospital to an airport medic.

Recent advancements in and increasing availability and utilization of, Telehealth by the general population have been the biggest drivers of telemedicine over the past decade, rapidly creating new possibilities for health care service and delivery. This has been true for developing countries and underserved areas of industrialized nations. The replacement of analog forms of communication with digital methods, combined with a rapid drop in the cost of Telehealth, has sparked wide interest in the application of telemedicine among healthcare providers, and have enabled health care organizations to envision and implement new and more efficient ways of providing care.

The introduction and popularization of the Internet has further accelerated the pace of Telehealth technology advancements, thereby expanding the scope of telemedicine to encompass Web-based applications (e.g., e-mail, teleconsultations, and conferences via the Internet) and multimedia approaches (e.g., digital imagery and video). These advancements have led to the creation of a rich tapestry of telemedicine applications that the world is coming to use.

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Types of Telemedicine

Telemedicine applications can be classified into two basic types, according to the timing of the information transmitted and the interaction between the individuals involved—be it health professional-to-health professional or health professional-to-patient.

Types of Telemedicine, Types of Telehealth

Live Video and Audio – (Real-time, or Synchronous) telemedicine This is the most common use of Telemedicine

Synchronous Telehealth
  • Typically, between Provider or Clinician group of Patient
  • It can be between a Provider and Provider for Consultations

When using secure and encrypted platforms, users will find it very similar to using Face Time, business Video Conferencing so common today.  DO Not be fooled by this similarity. Yes, companies like Zoom do offer a HIPAA Compliant Telehealth product but it not to be confused with lower cost standard business meeting audio-video conferencing system so popular today.

A legitimate Telehealth technology company will offer much more security that may not be apparent at first to the casual user. Check out the security and functionality of Drexly Telehealth solutions

Key difference in Telemedicine

  • Secure connectivity that is encrypted with Military-grade 256-bit AES encryption for all everything in the tool.  Video, Audio, File Sharing, Text messaging, and Voice calls will be encrypted at this level.
  • Storing of Patient Protected Information (PHI) – HIPAA regulations are clear that there are essentially three key parties engaged and responsible for the protection of patient medical information.
  • Provider, Clinician, or Hospital – Providers are still expected to follow HIPAA protocols in Telehealth delivery. Those that make the mistake of thinking that PHI can be treated like a fax machine (where they can fax consults and medical records out will find this mistake to be a costly one)
  • Staff or entities engaged in healthcare delivery operations that have a reasonable need to access PHI – Again, this requirement has been in place for years, and most of us are aware that PHI needs to be limited to those on a need to know basis.
  • THE PATIENT – the forgotten stakeholder for patient protected health information Those entities that have a reasonable need to have access to a patient PHI to conduct The, third, and probably the most important of these three parties is often forgotten about or even to a certain degree disregarded completely. Who am I talking about?  The PATIENT! 
  • HIPAA regulations, when they were drawn up and subsequently amended over the years, have always put the patient as a key part of the protection and responsibility of their own PHI. However, many providers, whether through ignorance or an overabundance of caution, have substantial barriers for the actual patient to obtain even paper copies of their medical records, let alone electronic versions of them.  However, a HIPAA Compliant Telehealth platform provides a secure direction transmission of all PHI between provider and patient.  The patient can then decide on their own with whom they wish to share their medical records.  For the latest information, new regulations on patients and their PHI see HHS Proposes new Rules to Improve the Interoperability of Electronic Health Information.

Because this encryption entails a direct link between user and sender, ensure you ask this question during evaluation. For more information on setting up a HIPAA Compliant Telehealth Program, see our article “HIPAA Compliance Tips.”

Telemedicne Store-and-forward, or asynchronous

Involves the exchange of prerecorded data between two or more individuals at different times.

  • For example, the patient or referring health professional sends an e-mail description of a medical case to an expert who later sends back an opinion regarding diagnosis and optimal management.
  • Another example is when a patient receives an X-Ray, and the Radiologist reads the fill from a remote geographic location from where the patient received the actual diagnostic service

In both synchronous and asynchronous telemedicine, relevant information may is transmitted in a variety of media, such as text, audio, video, or still images. HOWEVER, ALL SHARING OF PATIENT PHI NEEDS TO BE DONE THRU A SECURE ENCRYPTED SYSTEM THAT IS ENCRYPTED AND HIPAA

Telemedicine Remote Patient Monitoring (RPM) or Remote Care Monitoring (RCM)

Telehealth Transformation

RPM/RCM is considered a subset of Telehealth that facilitates patient monitoring as well as the timely transfer of patient-generated data from patient to care team and back to the patient. To capture patient data, RPM can employ a host of wired or wireless peripheral measurement devices such as:

  • Implantable devices
  • Biosensors
  • Blood Sugar monitoring for diabetics
  • Blood pressure cuffs, glucometers, and pulse oximetry.
  • Sensors that collect data passively (e.g., beacons in a home that can transmit data on movement and specific activity/inactivity).
  • In many cases, the patient themselves can enter their own data (weight, blood pressure, blood sugar, etc.)

RPM/RCM technology can usually then do the following with the patient’s data:

  • Store the data in secure records systems.
  • Transmit data, so it is accessible to clinicians or care monitors.
  • Flag abnormal readings or responses.
  • Alert clinicians/caregivers and patients to abnormalities via e-mail or text messages.

In response to these alerts, clinicians/others can log into the system, review data, follow up with patients, or take other appropriate actions. Some systems have the capacity to connect patients with additional resources such as patient health records (PHRs), or electronic medical records (EMRs), targeted educational materials, interactive self-care tools, medication.

All the above is a bit confusing, but the key is to use the technology to get familiar with it.  Just remember that things like the considerable costs to start and implement telehealth technology are a thing of the past, and almost all of them are cloud-based and relatively easy to get going. 


DO NOT FORGET Telemedicine requires Business Associate Agreement with Telehealth Company

Last essential requirement, and this is not optional, is legitimate Telehealth companies will ensure that a HIPAA Business Associate Agreement (BAA) is put in place with your practice and their company. For your office to sign, which protects you from the provider in case of a data breach. A BAA, at its core, is the commitment of the parent organization, provides all this security to take the risk for a violation.  DO NOT sign up with a company if they do not have this is standard.   See our article “Importance of HIPAA Compliant Telehealth

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