Telemedicine


Article Author:
Dac Teoli


Article Editor:
Narothama Aeddula


Editors In Chief:
Dustin Constant
Donald Kushner


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Trevor Nezwek
Radia Jamil
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Beenish Sohail
Nazia Sadiq
Hajira Basit
Phillip Hynes


Updated:
12/16/2018 2:52:51 PM

Definition/Introduction

Telemedicine started in the 1950s with several hospital systems shared images along with information by telephone. It slowly developed in time from sending radiographic images into connecting a physician with a patient with a specialist elsewhere. US military and aerospace sectors advanced the telemedicine in the 1960-70s by using the information and communication technologies to provide medical care in remote areas.

As one could imagine, in the earlier days of medicine, they viewed this concept of geographic reach with great potential, especially for citizens in rural regions without access to specialist care. As with most facets of life throughout the 20th century, technology advanced and capabilities correspondently increased. With new equipment and devices, remote physician visits became possible, albeit remained highly resource-intensive and expensive.

Telemedicine broke out of its limited utility with the development of the internet. Further advances were spearheaded by the rise of portable computers and, subsequently, smartphones. By being able to transmit high-quality video and audio in real-time at relatively low costs, the potential for telemedicine actualized into private homes, offices, and living facilities. Providing an alternative to in-person visits provided those same patients with access to care often they might not have had across both primary and specialty care.

While often confused with the term and concept of "telehealth," telemedicine differs in scope. While the latter focuses on electronic devices to permit communications regarding clinical services (follow-ups, medication management, specialist consultation), the former is much broader in practice. Telehealth uses technology to empower and improve healthcare as a whole. Telehealth includes non-clinical services, such as administrative communication, meetings, and training.[1]

Issues of Concern

There are numerous issues of concern within telemedicine. Some significant concerns include reimbursement, patient privacy, diagnostic accuracy, lack of physician-patient relationship, liability, security, regulatory issues, and technology-related barriers.

There is no universal federal standard for reimbursement of telemedicine visits or services. Each state is responsible for addressing their own rules and approaches to the matter. While some states require the same reimbursement across telemedicine and in-person services, other states leave it up to the payers/insurance to address. This trend holds true for many developed regulations and complexities with reimbursement for Medicare and Medicaid. 

As with all data sent electronically, it is subject to being intercepted, stolen, or misused in some fashion. HIPAA and similar regulations prove to remain a focal point of concern for many clinicians and patients. These same requirements mandate that data be encrypted to protect patients, and thereby rule-out ubiquitous programs such as Skype and Google chat for specialized solutions.

The lack of direct contact between a patient and physician provider can create problems of its own regarding diagnostic accuracy and the physician-patient relationship.

In that same light, another concern is the technology itself, specifically the accessibility and usability. In order to be functional, the software must be easily operational and straightforward. Some clinicians get intimidated by feature overload and complex graphical user interfaces. Likewise, the general population is also at risk of being overwhelmed - especially if they belong to a demographic that is not well-acquainted with similar technology (email, text message, video chat). As such, it is imperative that patients receive suitable training on how to operate their devices and/or programs effectively.[2]

Clinical Significance

Telemedicine offers both physicians and patients an alternative to in-person visits and services. As such, both parties can enjoy several benefits, whether using telemedicine for follow-up visits, medication management, remote post-hospitalization care, assisted living support, or school-based services. Overall, patients benefit from potentially less time away from family, home, and work. Patients can save money on travel expenses. Patients can have a new layer of privacy and also not physically expose themselves to other patients potentially harboring contagious illnesses. Physicians benefit from reaching new patient populations without requiring additional travel, improved revenue, and often excellent private payer reimbursement. Furthermore,  physicians gain from having less missed appointments and better patient follow through and compliance.[3][4]

The two critical care physicians, Dr. Rosenfeld, and Dr. Breslow, at the Johns Hopkins Hospital, Baltimore, developed the initial technology for the electronic ICU (e ICU) in 1998. Ever since the eICU has expanded to many hospital systems across the world. 

The 21st-century telemedicine applications go well beyond the remote clinician’s capabilities of diagnosis and therapeutic interventions to demonstrated capabilities in telesurgery, remote psychotherapy, and virtual home visits to manage chronic medical problems. 


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Telemedicine - Questions

Take a quiz of the questions on this article.

Take Quiz
Select the choice that is the best example of the earliest telemedicine practice:



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Select the choice used in telemedicine that is specifically intended to increase the patient's level of independence:



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is least used in telemedicine?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is true of telemedicine?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which liability is outside the practitioners' scope of accountability when practicing telemedicine?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
In what way does telemedicine differ from telehealth?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 62-year-old female with hypertension and type 2 diabetes presents for introduction to the newly adopted mobile electronic medical application. Which of the following is a solution to a frequently encountered complication with telehealth service that is not encountered with telemedicine service?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Telemedicine - References

References

Goedeke J,Ertl A,Zöller D,Rohleder S,Muensterer OJ, Telemedicine for pediatric surgical outpatient follow-up: A prospective, randomized single-center trial. Journal of pediatric surgery. 2018 Oct 4     [PubMed]
von Wangenheim A,Nunes DH, Creating a Web Infrastructure for the Support of Clinical Protocols and Clinical Management: An Example in Teledermatology. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2018 Nov 30     [PubMed]
Maleki M,Mousavi SM,Khosravizadeh O,Heidari M,Raadabadi M,Jahanpour M, Factors Affecting Use of Telemedicine and Telesurgery in Cancer Care (TTCC) among Specialist Physicians Asian Pacific journal of cancer prevention : APJCP. 2018 Nov 29     [PubMed]
Wood PR,Caplan L, Outcomes, Satisfaction, and Costs of a Rheumatology Telemedicine Program: A Longitudinal Evaluation. Journal of clinical rheumatology : practical reports on rheumatic     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Surgery-Podiatry Cert Medicine. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Surgery-Podiatry Cert Medicine, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Surgery-Podiatry Cert Medicine, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Surgery-Podiatry Cert Medicine. When it is time for the Surgery-Podiatry Cert Medicine board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Surgery-Podiatry Cert Medicine.