Telemedicine, also known as telehealth, is the practice of using technology to deliver medical services at a distance. It occurs by using a telecommunications infrastructure to connect a patient (at the original place of treatment) and a physician, or other practitioner that is licensed to practice medicine, in remote regions and communities. Telemedicine allows physicians to treat patients by providing on-demand healthcare without wasting time or costs of in-person visits.
Telemedicine has been used since the 1960s, thanks to NASA who built telemedicine technology into early space crafts and space suits in order to monitor their astronauts’ health during missions. In 1964 and 1967, telemedicine technology was linked to the Norfolk State Hospital and the Massachusetts General Hospital for providing consultations and medical care to remotely located patients. By the early 1970s, the US Department of Health, Education and Welfare (HEW) funded telemedicine research projects in New York, Boston and Chicago.
Physicians often don’t actually need to touch a patient to make a diagnosis and the latest technology – video conferencing, smartphone apps, online management systems – enable them to see exactly what they need to help patients.
What telemedicine means for physicians
For physicians, telemedicine is a growing field that allows them to deliver high standards of care without the associated overhead. 90% of health leaders are developing or implementing telemedicine technology. 64% of telemedicine programs offer remote monitoring whilst 35% of employers with on-site health facilities currently offer telemedicine services. But would Americans be happy with a video visit to discuss a health issue? According to AdvancedMD
, 64% of Americans said yes, they would be willing to have their doctor visit conducted via video.
The AAFP (American Academy of Family Physicians) supports the use of telemedicine as an efficient way of improving health when conducted in a way that is supportive of longitudinal care within the appropriate levels of care. They also state that physicians should be compensated for services that are reasonable, safe and effective, medically appropriate and provided within the accepted standards of medical practice.
Who would use telemedicine services?
The use of telemedicine services has been shown to reduce the barriers to accessing health services where there have previously been issues due to large distances between the patient and the medical provider, reliable transport, intermittent care because of excessive gaps between appointments, and a lack of available physicians locally. Large distances between patients and physicians can mean that access to care is limited but with telemedicine services, this geographical restriction can be overcome and is particularly applicable to patients who are located in more remote regions and communities.
A recent study by Pub Med demonstrated the benefits of telemedicine care for patients and resulted in:
- 38% fewer hospital admissions.
- 31% fewer hospital re-admissions.
- 63% more likely to spend fewer days in hospital.
- More patients were better engaged in their own healthcare.
Reimbursement for patients that pay privately, and Medicaid policies vary widely according to state and private payer telemedicine services plans. However, Medicare coverage, although limited to specific services within allocated rural or health professional shortage areas (HPSAs), does not vary.
What are the benefits?
The benefits of telemedicine services include:
- Patients received personal face time without the hassle of commuting.
- Technology offers seamless integration which keeps physician’s overheads low thereby keeping costs down for patients.
- Physicians are able to offer in-house specialist consulting to diagnose patients in less time.
Patients are more engaged in their own health care, physicians are able to treat more patients and the quality of patient care is improved as telemedicine services offer a patient-centered approach. According to a Cisco global survey, 74% of patients prefer easy access to healthcare services over in-person interactions with providers - convenience is the key.
Remote analysis, monitoring services and electronic data storage can significantly reduce healthcare service costs, saving money for providers, patients and insurance companies. It can also reduce non-urgent unnecessary ER visits and eliminate transport costs associated with regular check-ups. In addition, telemedicine services can boost revenue by turning on-call hours into billable time, attract new patients, and reduces no-show rates for physicians who decide to move to a flexible work-from-home option.
Leading telemedicine healthcare specialities
Although telemedicine is becoming increasingly popular with physicians across the whole medical sector, not all areas of medical care can benefit from the use of telemedicine services. American Well, a provider of telemedicine services, conducted a survey
, gathering information from over 2,000 primary care physicians on the topic of video consultations. The survey revealed 10 key medical specialities that physicians have found particularly suited to the use of telemedicine services:
- Dermatology – 76%.
- Psychiatry – 54%.
- Infectious diseases – 46%.
- Pain management – 37%.
- Neurology – 36%.
- Cardiology – 34%.
- Rheumatology – 32%.
- Gastroenterology – 24%.
- Sports medicine – 18%.
- Oncology – 17%.
Another principal area that telemedicine services can be beneficial is pediatrics. Every parent’s worst nightmare is a sick or injured child, especially when they live in a rural or remote area. Combine this with a significant shortage of pediatricians and it leads to long waiting times and overcrowded doctors’ waiting rooms. While providing care via a video consultation is not the same as a visit to the ER, it does help to prevent unnecessary visits or to fill the gap created by a shortage of physicians. It can also provide vital support to parents with children who suffer from chronic conditions, such as asthma, diabetes and epilepsy. An American Academy of Pediatrics policy
statement concluded that “the use of telemedicine technologies can help reduce missed appointment rates, increase adherence to recommended therapies, and help ensure the appropriate frequency of recommended physician visits.” In addition, The American Psychological Association (APA)
also points out that telemedicine and mental health services have long been successfully associated with each other.
Is telemedicine for you?
There is a range of telemedicine providers that physicians can work with; many provide these services along with traditional doctor/patient coverage, often supplementing a private practice income. Physicians are usually paid per patient or per consultation and most providers offer a base rate per hour payment option. For the majority of physicians, it would not be feasible to run their practices based upon offering only telemedicine services.
, founded in 2002, was the USA’s first and is now the largest telemedicine provider. Physicians who wish to use telemedicine services must complete training, such as how to conduct a consult with a patient, how to use the telemedicine provider’s website and how to improve listening skills. Once a physician has determined how much spare time they have available, it is possible to calculate how many telemedicine consultations can be achieved effectively.
Another telemedicine provider, HealthTap
, describes itself as a leading digital health hub. With digital technology at the forefront, being able to respond quickly to a request for a live consultation almost anywhere is very much an added bonus for the physician and the patient. As with Teladoc
, training is provided explaining how to use their telemedicine services via a series of webinars, including such topics as setting up your computer and performing a consultation.
For most physicians starting out in telemedicine, the number of patients and the hours dedicated to the service is low. Over time, though, this will increase with some physicians consulting between four and five hours of their time a day. But this isn’t always on consultations. Doctors are encouraged to answer questions, interact with other doctors, and become involved in conversations online, which increases your patient exposure.
- Technology – telemedicine services are based on technology; the better the technological support from the telemedicine provider, the more successful the physician will be.
- Telemedicine supports nurses – the nurses that work for telemedicine providers are a vital connection between the physician and the patient. From direct call back numbers to providing prescription calls to pharmacies, a good telemedicine nurse can be the difference between failure and success.
- Malpractice coverage – as a physician, it is recommended that the telemedicine provider of your choice is able to provide malpractice cover within the state of your licence.
- Document your consultations – because physician/patient consults take place remotely, via a phone or video or other means, it is important to ensure that the conversation is documented together with any symptoms, the diagnosis and any treatment. It is also important to make careful patient notes.
The average telemedicine physician’s salary range in the US is from $123,000 to $278,000 a year. With more and more people using online digital services, around 70% of people are able to meet with their healthcare needs as they require, and often at lower rates.
While telemedicine doesn’t replace the emergency or urgent care, it may go a long way to relieving the pressure on primary care.
Telehealth Index: 2015 Physician Survey
, American Well conducted with Quantia MD (2015) American Well
Leveraging Remote Behavioral Health Interventions to Improve Medical Outcomes and Reduce Costs.
Reena L. Pande, MD, MSc; Michael Morris; Aimee Peters, LCSW; Claire M. Spettell, PhD; Richard Feifer, MD, MPH; William Gillis, PsyD; February 2015 - American Journal of Managed Care
The Use of Telemedicine to Address Access and Physician Workforce Shortages
, Committee on Pediatric Workforce; July 1, 2015 – American Academy of Pediatrics
A New Emphasis on Tele Health: How Pyschologists Can Stay Ahead of the Curve and Keep Patients Safe
, Amy Novotney; June 2011- American Psychological Association
Telemedicine, also known as telehealth, is the practice of using technology to deliver medical services at a distance.