Telehealth, also referred to as telemedicine or e-medicine, is the remote delivery of healthcare services over the telecommunications infrastructure.
Telehealth allows healthcare providers to evaluate, diagnose, inform and treat patients without an in-person visit. Patients can communicate with physicians from their homes using their own personal technology or by visiting a dedicated telehealth kiosk.
A typical telehealth exam involves downloading an application or calling a telehealth number, provided by a physician's office or patient's employer as part of health insurance benefits. After sharing information about medical history and symptoms, the remote patient will be connected to a clinician. Based on the clinician's evaluation, the call will end with the patient receiving further instructions, such as what over-the-counter or prescription medication to take, and whether they need a follow-up appointment.
Telehealth can be classified into four main categories that in some cases overlap.
Some of the benefits of telehealth for patients include the following:
Telehealth also provides advantages to providers, including the following:
Some of the challenges of telehealth include the following:
Telehealth visits often are a less expensive way to provide medical care for both patients and providers. Health insurers often provide financial incentives to encourage patients to make use of telehealth services.
There are a variety of payment models used for telehealth services. Some health systems offer telehealth consultations as part of their regular care services; payers charge patients based on insurance plans or government reimbursement schedules. In other cases, a patient's employer offers a virtual care option as part of health insurance coverage premiums. Some people may opt to independently use a telehealth vendor for a flat fee.
The Centers for Medicare & Medicaid Services expanded telehealth access and reimbursement in the federal Physician Fee Schedule in response to the increased need for telehealth during the COVID-19 pandemic. The public health emergency is set to end on May 11, 2023, as of this writing. Many Medicare telehealth provisions authorized during the public health emergency were extended by the Consolidated Appropriations Act of 2023 through Dec. 31, 2024.
In recent years, many states have passed laws that make telehealth easier to provide. Federal health regulators are exploring ways to extend Medicare reimbursements for telehealth services beyond December 2024.
Although the Patient Protection and Affordable Care Act of 2010 governs telehealth in certain situations under Medicare, telehealth regulation for the most part falls to the states. As of spring 2018, 49 states and the District of Columbia provide reimbursement through Medicaid for some type of live video care, according to the Center for Connected Health Policy, a group that promotes telehealth.
Laws about how prescriptions are issued through telehealth consultations vary by state, as well. The general trend is that more states allow these online prescriptions; however, some states require the establishment of a doctor-patient relationship. Until recently, virtual visits did not qualify as a legitimate doctor-patient relationship in some states.
Telemedicine used to be considered a subset of telehealth, but the two terms are now synonymous.
In the past, the label telehealth included nonclinical services, such as continuing medical education, provider training and administrative meetings. In contrast, telemedicine originally only pertained to the use of electronic communications to provide clinical services without requiring a patient to come into a healthcare provider's office or hospital.
The U.S. Federal Communications Commission sometimes uses the term e-care as an umbrella label for any electronic exchange of information that aids in the practice of advanced analytics and medicine.
The development of modern telehealth began with the invention of the telecommunication technology and infrastructure, including the telephone and telegraph. Early on, telehealth technology was used in military situations. For example, during the Civil War, telegraph messages were used to order medical supplies. Casualty and injury lists were also delivered via telegraph.
The first transfer of a medical image occurred in 1948 in Pennsylvania, when radiology images were sent 24 miles between two townships via telephone line. A few years later, Canadian radiologists created a similar teleradiology system for use in Montreal. In 1959, clinicians at the University of Nebraska transmitted neurological examinations across campus to medical students using two-way interactive television.
Early computer-based patient records were in use in the 1960s. Electronic medical records (EMR), also called electronic health records, started to be more widely used in the 1980s. As part of the American Recovery and Reinvestment Act, healthcare providers were required to show "meaningful use" of EMRs by Jan. 1, 2014, to maintain their Medicare and Medicaid reimbursement levels.
In the early days of telehealth, healthcare professionals used the technology to reach patients living in rural areas. However, the technology quickly expanded into urban areas, especially those that suffered from healthcare shortages.
As healthcare providers seek more efficient ways to provide care at less cost to the patient, telehealth's role has grown. The use of virtual healthcare grew during the pandemic. It is likely that telehealth use will continue to grow and be incorporated into the healthcare provision worldwide.
Telehealth will continue to incorporate technologies like artificial intelligence and machine learning to provide predictive healthcare analytics and mine emergent medical data. As telehealth technologies advance, there will be a need for regulatory oversight and reform to ensure patients are protected.
The internet of things (IoT) is likely to play a significant role in the future of telehealth. However, healthcare IoT comes with several cybersecurity risks that endanger patient data. Learn the risks of healthcare IoT and how to mitigate them.
24 Feb 2023