What is Telemedicine?

Defined as the virtual delivery of care through HIPAA compliant technology including text messaging, video conferencing, and store & forward.  It expands access to care providing populations with chronic care, behavioral health, primary care, and other specialties. Proven to be an effective means of increasing patient compliance and reducing the overall cost of care.

History

The term “telemedicine” was coined in the 1970s by Thomas Bird and it was derived from a combination of Latin and Greek, “Tele” and “Medicus”, meaning “healing from a distance”.  Distance-based healing originated well before the term “telemedicine” existed.  The first example of using technology to deliver care from a distance involved remote monitoring of patient electrical cardiac signals from nearly 1 mile away from the hospital where patients were receiving care.  This was achieved in the early 1900s by Dr. Willem Einthoven utilizing a string galvanometer that he designed and was the birth of clinical electrocardiography.

By the 1960s, technology progressed to represent the modern form of telemedicine.  Military and space industries were the first to create and adopt the technology required to deliver this modern care.  In July 1969, the world watched Neil Armstrong and Buzz Aldrin land on the moon.  Via video, audio, and remote monitoring, the two astronauts communicated with Mission Control while physicians monitored pulse rate and breathing from 238,900 miles away.

Dr. Willem Einthoven –

Father of Telemedicine

Telemedicine Technology

The first enterprise applications of telemedicine were achieved through Session Initiated Protocol based-signaling (SIP) backed by significant hardware technology.  Health systems implemented SIP platforms to leverage specialists across their network, especially into populations and rural communities that simply didn’t have access to the care they needed. Infrastructure and tech requirements were extensive and usually included a significant deployment of Telemedicine Carts that cost upwards of $15,000.  The end result is a point-to-point network of telemedicine end-points that are limited to uses inside health systems and provider networks.

Legacy Telemedicine Tech

 

With the advancement in the internet, web development, and cloud-based computing, infrastructure requirements and costs have been dramatically reduced by shifting processing from hardware into software and the cloud. Today high-quality virtual care can be achieved with a laptop or iPhone and VisuWell’s cloud-based telemedicine platform.  In many cases, legacy SIP implementations are being advanced through SIP integration with newer cloud-based platforms that allow SIP access points to extend care to consumer-based devices, bridging old technology with new.

Consumer Enabled SIP Telemedicine End Points

 

Telemedicine vs Telehealth

Telemedicine and Telehealth are terms that are used synonymously, but there is a differentiation between the two.   Telehealth is more broadly defined as clinical and non-clinical services that range from diagnosis and management to education and even health and wellness apps.  

Telemedicine is only reserved to distance-based clinical diagnosis and monitoring that is delivered by technology.  According to the American Telemedicine Association, “Telemedicine includes a growing variety of virtual care applications and services that use two-way video, email, smartphones, wireless tools, and other forms of telecommunication technology.”

In summary, telemedicine can best be described as a subset of telehealth.

Applications

There are broad use cases and applications for telemedicine that are not limited to the following:

Patient Intake: An integrated telemedicine platform can streamline patient intake for both virtual and in-person care settings.  Through the VisuWell portal patients can easily fill out forms and assessments that directly import into EHR patient files.  Progressive health systems and practices are utilizing online intake to reduce wait times and administrative burden while improving patient satisfaction.

Chronic Care Management and chronic conditions are an estimated 75% of the total cost of health care in the United States.  Improving outcomes in populations with chronic conditions represents the single greatest opportunity to decrease healthcare costs and improve patient health, but traditional care models are cost-prohibitive.  Through telemedicine, the cost for check-ins decreases to manageable levels while providing the ability to quickly change care plans based on changing biometrics and other factors.

Virtual Behavioral Health Integration is the process of incorporating remote behavioral health professionals into primary care and other healthcare settings.  It has been a proven success for improving overall health outcomes for multiple patient populations.

Remote Patient Monitoring uses digital technologies to collect medical and other forms of health data from individuals in one location and electronically transmit them to providers and care team members in another location.  This is traditionally utilized in chronic care populations and in rural health centers that are receiving consults from specialists in other locations.

Follow-Up Visits are time-consuming and resource intensive for both providers and patients.  Through telemedicine, follow-up visits become more efficient and have been statistically proven to increase appointment completion – positively impacting revenue, costs, and outcomes.

Long-Term Care facilities have a responsibility to care for the health of all residents, and that requires providing access to a broad spectrum of health services.  Telemedicine removes transportation burden for residents and providers making it more cost effective to provide the care residents deserve.

Post-Discharge Care is of growing importance for health systems and hospitals.  New revenue models are negatively impacted by increasing readmission rates, but impacting readmission can be a challenge when costs are a factor.  Telemedicine provides a cost-effective means for check-ins that removes the time and challenges associated with traveling to the doctor.  Through virtual check-ins, it is possible to identify risks that contribute to readmission and adjust care plans to prevent costly ER visits.

Specialties

Most specialties can benefit from telemedicine or virtual care delivery.  Some examples include:

Telemedicine Endocrinology | With rising obesity rates and increases in diabetes populations, endocrinology specialists are in short supply.  These factors resulted in early adoption of telemedicine through initiatives like Project ECHO at the University of New Mexico.  Through virtual care, endocrinologists are expanding access to care through consultations with primary care providers and directly serving patients that are hundreds of miles away.

Primary Care Telemedicine | Primary care physicians serve the largest swath of patients but receive the lowest reimbursement rates for traditional care.  Meanwhile, these groups are experiencing patient leakage to higher cost services from urgent care and national telemedicine organizations.  Through telemedicine, primary care groups can retain patients, improve quality of care, and reduce the total cost of care for patients and health systems.

Telemental Health | Telehealth has been widely adopted and supported across behavioral health due to shortages and epidemics ranging from suicide to drug abuse.  Reimbursement for telemedicine has been widely supported for telemental health across Medicare, Medicaid, and private insurers.

Obgyn Teleobstetrics | Teleobstetrics provides increased access to all expecting mothers and drastically improves outcomes for high-risk populations.  Realize improved outcomes and create a better patient experience by implementing telemedicine in your OB/GYN practice.

Pediatric Telemedicine | Parents are busier than ever and pediatric care is commonly needed outside of traditional office hours.  Telemedicine provides after-hours and weekend access for parents that have been forced to higher cost solutions with urgent care centers and emergency departments.

Urgent Care Telemedicine | Urgent care centers are utilizing telemedicine to balance patient loads between high demand and low demand locations.  Virtual care also provides a means to cultivate stronger relationships with employer referral sources along with providing increased convenience for patients.

Advancing Care & Increasing Access

Telemedicine is really just another means of providing care.  Unlike traditional care delivery, telemedicine is uniquely suited to resolve the main challenges in health care, whether it be cost, time, engagement, or patient compliance.  Some examples of

Decreasing Cost & Increasing Throughput
Telemedicine offers many improvements over traditional/analog care models.  Scheduling, patient intake, follow-up appointments can all be accomplished online and with decreased administrative burden.  By integrating virtual care, provider groups will realize lower costs and increased capacity.

New Revenue Opportunities
Telemedicine provides new revenue opportunities for services that were previously non-reimbursable, like after-hours phone calls and prescription refills.

A Better Patient Experience
Patients are demanding easier access to their providers and a faster way of managing all aspects of care.  Telemedicine is the leading solution for creating the experience patients are seeking.

Improving Outcomes
Creating healthier patients requires engaging patients outside of standard appointment cycles.  Telemedicine provides a timely and cost-effective means for increased touchpoints along with remote monitoring of patient vitals, bringing patients back to the center of care.

Decreasing Patient Leakage
Provider groups are seeing more competition from health systems, urgent care centers, and large telemedicine provider groups.  By launching private labeled telemedicine solutions, innovative providers are able to improve access for patients, dramatically d

Telemedicine Devices

In order to provide proper care that patients and consumers demand, telemedicine devices need to become as ubiquitous as the thermometer.  Fortunately, advancements in technology will make this a reality.  Today, patients are using Bluetooth-enabled blood pressure cuffs and glucose meters to collect vitals and store them on their smartphones.  Meanwhile, medical organizations are using digital otoscopes, stethoscopes, and other digital devices to provide remote care.  It’s simply a matter of time before a telemedicine-device kit becomes a part of every home first-aid kit.

Growing Reimbursement Opportunities

Legislators and insurance payors were slower to support virtual care delivery, but a lot has changed over the last few years.  As of January 2019:

  • 49 states and Washington, DC have legislation that allows for Medicaid reimbursement for some form of live video.
  • 39 states have parity laws requiring that telemedicine services be reimbursed at the same rate as in-person care.
  • Medicare continues to advance reimbursement for virtual care, especially for behavioral services and rural populations.

Telemedicine reimbursement continues to improve through state and federal legislation, along with updates with individual payors.

Learn About Reimbursement

Telemedicine Reimbursement By State

Telemedicine Reimbursement By State

HIPAA Compliance & Security

HIPAA is the Health Insurance Portability and Accountability Act that provides provisions for data security and safeguards for medical information.  It governs how medical and Personal Health Information is managed.

HIPAA compliance and security are paramount to telemedicine.  As with all forms of health care, the security of personal health information, PHI, is paramount.  A robust telemedicine suite must provide technological safeguards designed to protect PHI.  Examples of this include:

  • Messaging should be managed through a secure portal
  • Data must be secured and encryption is recommended
  • The company supporting the platform must offer a Business Associate Agreement (BAA) that legally obligates the organization to adhere to HIPAA and assume the risk for the responsibilities of managing PHI.
  • Other elements of HIPAA require business associates to maintain procedures and protocols for employees that may come in contact with PHI.

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