What is Telemedicine?

When you or a loved one is feeling unwell or even just uneasy about your health, the traditional protocol is to call your doctor’s office, given that they’re open, and call to schedule an appointment; even if it’s just to ask a few questions. In most cases, you would like to be seen as soon as possible, but chances are that you have to schedule an appointment for a future date which can sometimes be even up to several months away. If you really need immediate care however, it seems as though you might have to take a ride to the emergency room or an urgent care. As you might assume, that most likely won’t be one of the happiest trips you’ve had to go on.

Telehealth is a revolutionary approach to today’s healthcare industry. It is the process in which a patient can consult a doctor virtually through a digital device such as a smartphone, computer, or tablet. Today, some challenges of our current healthcare system include accessibility to health care, virus exposure and cost of care. Telemedicine solves these and other issues through its convenience, safety and cost effectiveness.

Telemedicine increases access to healthcare:

  • Patients only need a digital device such as a smartphone, computer or tablet to reach a provider.
  • Patients can enjoy the comfort of their home while getting the medical attention they need.
  • Patients can reach a provider within a matter of minutes, opposed to commuting to a medical facility and then having to wait in line
  • Providers are able to see more patients because of the ease of access

Telemedicine is safer than visiting a medical facility:

  • Patients can avoid exposure to potentially deadly viruses that people may bring to medical facilities
  • Patients can avoid spreading potentially deadly viruses as well
  • Patients diagnosed and treated earlier often have improved outcomes and less costly treatments.

Telemedicine is more cost-effective:

  • Because fewer variables are involved, a telemedicine visit will cost less than a physical visit in most cases
  • According to a 2017 study, the average estimated cost of a telehealth visit is $79 per visit compared to the average estimated cost of $136 to $176 for in-person acute care.

Telemedicine can increase productivity for providers and staff:

Telemedicine can reduce anxiety of patient, thus yielding a better experience and even a more accurate diagnosis

Telemedicine Do’s And Don’ts

Although telemedicine can be a quick solution to getting medical attention quickly, it is only intended for acute care. Telemedicine by no means should be used in emergency situations.

DON’T USE telemedicine for:

  • heart attacks
  • seizures
  • strokes
  • lacerations
  • broken bones
  • Suicidal thoughts
  • etc.

As a general rule, anything that requires immediate or hands-on care should be handled in-office.

DO USE telemedicine for:

  • flu
  • cold
  • allergy
  • viral infections
  • Pink eye
  • rashes
  • health concerns
  • medical advice
  • etc.

Please be aware that a telemedicine visit may still lead to an in-office visit depending on the circumstances of the situation.

Telemedicine Software Integration

The telemedicine approach can be utilized for several aspects of the health care process. From registration, to to service, to records, telemedicine can cover the whole spectrum from beginning to end.

Online Registration

  • Patients can fill out their information online
  • Patients can avoid the stress of flipping through physical documents
  • Patients can save time that they would otherwise spend waiting in a lobby

Video Call

  • Patients can consult a doctor from anywhere in the world (given they have internet access)
  • Patients can consult a doctor within a larger time frame than with a physical visit
  • Patients can save a lot of money compared to a physical office visit.

EMR (Electronic Medical Records) System

  • Patients records can be accessed remotely and at any given time by providers
  • Patients can keep track of their medical history so that they may gameplan efficiently with their doctor about their health
  • Providers can quickly send and receive records to any specialists (radiologists, gastroenterologists. etc.) for effective treatment

Telemedicine Debunked

Requires technical training and equipment

Like most technology solutions, telemedicine platforms usually require some training and equipment purchases. How much is really dependent on the solution – a more extensive inpatient telemedicine platform that will be used between primary doctors and consulting specialist may require more training and the purchase of a telemedicine cart and various mobile health devices. A secure videochat app like eVisit, requires much less staff training and usually only requires purchase of a webcam.

Some telemedicine models may reduce care continuity

Telemedicine companies that are consumer-facing offer the huge benefit of on-demand care for patients. A sick patient can simply login online and request a visit with one of the telemedicine company’s doctors and get treatment. But this model, similar to the retail health movement, leads to a breakdown in care continuity. A random doctor who doesn’t know the patient, doesn’t know their whole medical history. The best approach to telemedicine? Providing tools to providers to easily connect with their own patients.

Virtual visits may reduce in-person interactions with providers

Some people may argue that since telemedicine visits are virtual, patients may begin to lose a personal connection to their doctor. But let’s not forget all the ways people stay in touch today. Phone calls, Facetime (video calls), social media platforms are all one of many ways that humans stay connected in this age. In fact, one could argue that all these forms of communication and staying in touch are more beneficial than just having one means of communication. It allows for a fuller experience. Also keep in mind that telemedicine visits are not meant to replace in-office visits. They are intended to supplement them, just like multiple forms of communication do.

In-office visits are definitely valuable and necessary in many circumstances and that’s why telemedicine is good to supplement it for simple things like follow-ups or check-ups. Minor or acute conditions such as infections don’t usually require an in-office visit. If a patient goes in-office for extraction of a foreign object, a telemedicine visit follow-up the next week could be beneficial. In situations like that, telemedicine can ultimately save time and money for all parties involved.

The Future of Telemedicine

With such rapidly growing advances in technology, we can only expect the future of telemedicine to be bright. More and more platforms are growing to facilitate and expand the usage of telemedicine. It is projected that telemedicine is set to be a $36.5 billion dollar industry by the year 2020. Here are a few ways we can expect to see in the future of telemedicine:

Remote Triage

  • Checking the heart rate of the patient via their smart watch (Apple Watch, Fitbit and other smart watches)
    • These devices can obtain heart rate, blood pressure, and even pulse information. This, in the future may be able to be shared directly to providers.
    • Performing procedures (even surgeries) via Google Glass
      • a surgeon at UCSF, Pierre Theodore, became the first in the country to receive approval from the Institutional Review Board to use Google Glass during surgery. The technology allows, MD, to pre-load CT and X-ray images into the device, and then see them during surgery in his peripheral vision, allowing him to compare the medical scan with the surgical site without taking his eyes off the patient.

Remote Patient Monitoring

  • Mental health being monitored via a program than can analyze facial expressions to determine someone’s emotional state.
  • Trackers like Fitbit can keep records of physical activity for monitoring and a patient’s physical health

Augmented Reality

  • In the comfort of their own home, patients can be fully immersed in a simulated digital environment using a VR headset
  • To entertain, educate, and distract young hospitalized children.
    • At a hospital in Liverpool, doctors use AR tablets to do this. They use an app that allows kids to choose avatars that will offer them entertainment, information, and support, as well as challenges that they can complete to unlock new content. Another hospital in Los Angeles found that VR headsets can also reduce anxiety and procedural pain among children during routine blood draws.  

Remote staff members

  • Can handle triage and other required tasks via remote which can allow for higher productivity and safety from infections

Telemedicine Limitations and concerns

Although telemedicine holds plenty of promise and benefits, there are still some factors that can be concerning to providers and patients. For providers, some may worry about how effectively they can treat the patient. With virtual visits, the only senses you have available are sight and hearing. With that being said, the sense of feeling is missing from the equation. There are some things that a doctor just has to feel around for in order to properly diagnose a patient. For instance, a young girl who did a virtual visit for constipation she was having was simply prescribed a laxative for the issue. As that didn’t seem to help, the same patient visited a doctor in person, who examined her adequately, felt around the back and felt a lump. The patient actually had lymphoma and died 6 months later.

Not to say whether it could have been avoided or not but the fact of the matter is that something was missed, that could not and should not have been.

Although much more of a case to case situation, the quality of the virtual visit video can hinder the quality of the visit. For instance, if the patient, or even the doctor is having connection issues, the video may look blurry or choppy and can even affect the audio. This may cause it to be  harder to accurately assess the patient.

Telehealth versus Telemedicine

Telehealth is broad and refers to electronic and telecommunication technologies used to provide services and care to patients in remote locations. Telehealth differs from telemedicine because it refers to a wider variety of healthcare services that are provided remotely. Telemedicine is covered within the broader scope of telehealth.

Telemedicine refers to clinical services that are done remotely, while telehealth can refer to non-clinical services done remotely. Telehealth covers patient health care education, public health, health administration and health information services.

Three main types of Telehealth:

  • Store-and-Forward – Medical history, lab reports, images, videos, etc., are collected and sent electronically for evaluation.
    • Benefits:
      • Patient, provider, and specialist do not all have to be available
      • No travel needed
      • Reports are received in a timely manner
      • Surgery and prescriptions are reduced
      • Quicker second opinions
      • More appointments available for those more in need
  • Remote Patient Monitoring – Technological devices are used to monitor patients in remote areas. This type of monitoring is used by patients who suffer from chronic diseases, such as diabetes and asthma.
    • Benefits:
      • Plans that are customized specifically for patients to help improve their self-health and care
      • Daily monitoring to help patients recover their health
      • Increased patient satisfaction
      • Patients will be more active in managing their own health through devices and apps they use at home
  • Real-Time Interactive Services – Video conference calls are used between provider and patient.
    • Benefits
      • No time needed off of work
      • No transportation
      • No need to find someone in a pinch to take care of children or elders
      • On-demand options
      • Access to specialists

Telehealth is more than just telemedicine:

  • Patients can use their phone or another device to upload medications and food logs for their nurse to review and respond electronically.
  • For diabetic patients, they can use an app to estimate how much insulin they need, depending on diet and exercise.
  • Patients can access their online patient portal to schedule appointments, view test results, and get refills on prescriptions.
  • Patients will be able to receive text messages, phone calls, and emails reminding them to schedule preventative care appointments.
  • Patients have the ability to order medications online and have them delivered to their house.

Improvements in care from telehealth:

  • Health care services are available for people who live in the country or more remote areas.
  • Services are convenient for people who have limited or no transportation, as well as people who have limited or no mobility.
  • Communication between the patient, provider, and team improves.
  • Providers and their team can better provide support for their patient’s self-care.

Telepharmacy

With telemedicine, patients are able to get prescription medications through a virtual appointment. After a telemedicine appointment, providers will either suggest an over the counter medication, or write a prescription. Telehealth services, such as online pharmacies can then deliver the prescription right to the patient’s door. There are some controlled substances that may not be able to be delivered. Pharmacies are regulated by state licensing boards; therefore each state has different laws on which prescription drugs can be delivered.

The most common prescriptions patients can order online and get delivered are:

  • Antibiotics
  • Allergy medication
  • Asthma medications

Online pharmacies can also deliver non-prescription medications. Controlled substances are more regulated.

Four types of telepharmacy:

  • Remote order-entry review (Inpatient) – Pharmacist reviews medication orders at a remote location before hospital staff administers medication
  • Remote dispensing – Remote dispensing pharmacy that is staffed with a pharmacy technician
  • IV admixture – Preparation of pharmaceutical product
  • Remote counseling – Psychotherapist meets with a patient through telecommunications

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