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Guide to Telemedicine: Past, Present and Future

With the growth of technology, telehealth and telemedicine are gaining increasing popularity amongst patients and clinicians alike. In much of the healthcare industry, the terms “telehealth” and “telemedicine” are often used interchangeably, however, they have two distinct meanings.

BodyHealth IQ uses the term Telehealth Wellness Consult to describe a remote consultation between a patient and a provider.

The term telehealth references a broad range of technologies and services to provide patient care. It is designed to improve the delivery of health care as a whole.  

Wikipedia, on the other hand, describes Telemedicine as the distribution of health-related services via electronic information and telecommunications technologies.  Telemedicine technology can be used for a number of different services including medication management, management of chronic health conditions, consultations, and follow-up visits. These services are conducted via secure video and audio connections, typically on a mobile device or a computer.

A brief history of telemedicine

Telemedicine was originally created as a way to treat patients who were located in remote places, far away from local health facilities or in areas of with shortages of medical professionals

Telemedicine allows clinicians and patients to initiate, follow up and complete health care related services without the patient having to physically visit the clinician.  Telemedicine also involves the use of electronic communications and software to provide clinical services to patients without an in-person visit. 

Ancient Greece and Rome around 500 BC saw the initial start of telemedicine where messengers would travel long distances to help spread information on medicine or disease.  With the invention of the telegraph and telephone, telemedicine was brought more into the mainstream as these technologies allowed anyone to make a phone call, order supplies and consult with their doctors.  

The modern version of telemedicine, what we are more familiar with first appeared in the April issue of Radio News Magazine.

The magazine showed how a patient used television and a microphone to communicate with a doctor.  

In more recent times the Internet has allowed the field of telemedicine to explode.  Increases in bandwidth, standardization of information such as radiology DICOM files and increases in the transfer speed have allowed clinicians to offer virtual treatment to their patients in a manner never before seen.

Who can practice telemedicine?

Physicians, nurse practitioners, physician assistants, residents and more can all deliver healthcare via telemedicine as long as the treatment is legal in the state.  Some specialties are more conducive to using telemedicine, as it is a more productive method to deliver care. The top 3 specialties that utilize telemedicine are:

  • Radiologists – 39.5%
  • Psychiatrists – 27.8%
  • Cardiologists – 24.1%
  • Specialties who use telemedicine the least include
  • Allergists/immunologists – 6.1%
  • Gastroenterologists – 7.9%
  • OB-GYN- 9.3%

Where is telemedicine legal & what can it be used to treat?

Telemedicine is legal in most states although each state has varying degrees of laws in specifically which medical procedures they allow to be performed.  This list is in constant flux as legislators in each state attempt to adapt to not only the technology but also the ever-changing rules regulating the telemedicine industry.

As long as it is legal in the state, providers can use telemedicine to diagnose a number of conditions.  For example, utilizing teledermatology, a photo of a rash, mole, or other skin abnormality can be sent to the physician for diagnosis.  Without access to telemedicine, the patient would physically have to travel to the provider, making the appointment potentially difficult for elderly patients or patients in more rural areas.

Telepsychiatry allows qualified psychiatrists to provide treatment to patients remotely resulting in expanded access to behavioral health for patients in need.  Without telemedicine, some patients may forgo to undergo treatment due to lack of access to care.

While telemedicine should not be substituted for situations where an in-person examination is required, many conditions in addition to the above such as allergies, asthma, bronchitis lower back pain, respiratory infections, diabetes, hypertension and more are all ideal clinical indications for the use of telemedicine.

Consults to discuss clinical issues, or the interpretation of test results, such as those tests provided by BodyHealth IQ are all ideal candidates for telemedicine.

If a patient is undergoing treatment via telemedicine, a patient-physician relationship must be established before any medication can be prescribed via a telemedicine contact.  

The American Medical Association describes the patient-physician relationship as a consensual relationship in which the patient knowingly seeks the physician’s assistance and in which the physician knowingly accepts the person as a patient.  The relationship encompasses 4 key elements:

  1. Mutual knowledge
  2. Trust
  3. Loyalty
  4. Regard

Insurance, Medicare and telemedicine

Most insurance companies have begun covering certain types of telemedical visits.  While coverage is not definitive, it varies by location, services provided and the payer.  There is no set standard for health insurance providers and the coverage is based on the preference of the individual insurance.

If we look at government provided healthcare such as Medicare, you will learn that Medicare has expanded the list of reimbursable telemedicine services but has restrictions on how the service is provided. 

Eligible providers that can bill under Medicare include physicians, nurse practitioners, physician assistants, nurse midwives, clinical nurse specialists, clinical psychologists, clinical social workers and registered dieticians.  

Medicaid coverage varies state by state and the policy for what is covered is constantly evolving. As of this writing, here is an overview of what reimbursement for telemedicine looks like with Medicaid across the different states.

  • 46 states Medicaid programs cover live video
  • 9 state Medicaid programs will cover store-and-forward telemedicine
  • 14 state Medicaid programs cover remote patient monitoring
  • 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.

Pros of telemedicine include:

  • More convenient and accessible patient care
  • Healthcare cost savings
  • Extended physician and specialist access
  • Increased patient engagement
  • Better patient care quality

Cons of telemedicine include:

  • Technical training and the equipment required
  • Reduced care continuity
  • Fewer in-person consults
  • Ambiguous insurance reimbursement rules

The Future of Telemedicine

With rapid advances in technology, it is logical that telemedicine will only continue to grow.  With advances in smart wearable technologies, more clinicians will offer preventative services for their patients because they can more easily monitor their conditions. Thus, potentially saving lives and dollars by doing more preventative care instead of the actual treatment of disease.

Advances in video technology will allow patients to submit symptoms and conditions with more clarity and ease to their physicians for diagnosis without having to submit to a physical visit.

Digital services such as the ones offered at Body Health IQ allow patients to not only remotely participate in testing, but to submit to a consult with a licensed provider and gain a deeper understanding of their test results.

By 2020, it is estimated that telemedicine will become a 36 billion dollar industry and a recent survey showed that 75% of patients report an interest in telemedicine.

Book a telehealth wellness consult with Body Health IQ today.