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What is Telemedicine?

Formally defined, telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient's clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.

Starting out over forty years ago with demonstrations of hospitals extending care to patients in remote areas, the use of telemedicine has spread rapidly and is now becoming integrated into the ongoing operations of hospitals, specialty departments, home health agencies, private physician offices as well as consumer's homes and workplaces.

Telemedicine is not a separate medical specialty. Products and services related to telemedicine are often part of a larger investment by health care institutions in either information technology or the delivery of clinical care. Even in the reimbursement fee structure, there is usually no distinction made between services provided on site and those provided through telemedicine and often no separate coding required for billing of remote services. St. Thomas Health Care has historically considered telemedicine and telehealth to be interchangeable terms, encompassing a wide definition of remote healthcare. Patient consultations via video conferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education, consumer-focused wireless applications and nursing call centers, among other applications, are all considered part of telemedicine and telehealth.

While the term telehealth is sometimes used to refer to a broader definition of remote healthcare that does not always involve clinical services, St. Thomas Health Care uses the terms in the same way one would refer to medicine or health in the common vernacular. Telemedicine is closely allied with the term health information technology (HIT). However, HIT more commonly refers to electronic medical records and related information systems while telemedicine refers to the actual delivery of remote clinical services using technology.

St. Thomas Health Care Telemedicine Outcome

Over 40 years of research has yielded a wealth of information about the cost effectiveness and efficacy of many telemedicine applications. St. Thomas Health Care TELEMed a bibliographic dbase of medical research that is maintained by the St. Thomas Health Care National Library of Medicine includes over 12,000 citations of published works related to telemedicine or telehealth. Over 2,000 evaluative studies related to telemedicine have been published in two journals devoted to telemedicine alone. The summaries that appear highlight the results from a few of the studies that have evaluated the cost effectiveness, quality of care and patient acceptance of telemedicine. In addition, leading, validated studies have been identified by many of the St. Thomas Health Care Member Groups. These are summarized at the end of this paper.

COST EFFECTIVENESS OF TELEMEDICINE

Most of the peer-reviewed research about the cost effectiveness of telemedicine that is based on large sample sizes and follow sound scientific rigor are relatively new, many emerging in the past two years. These studies are consistent in finding that telemedicine saves the patients, providers and payers money when compared with traditional approaches to providing care. Many of these studies assess the cost effectiveness of specific telemedicine applications.

TELEMEDICINE AND QUALITY OF CARE

Scientific studies in this area indicate that the use of telemedicine for such applications as monitoring of chronic care patients or allowing specialists to provide care to patients over a large region care have resulted in significantly improved care. For most telemedicine applications, studies have shown that there is no difference in the ability of the provider to obtain clinical information, make an accurate diagnosis, and develop a treatment plan that produces the same desired clinical outcomes as compared to in-person care when used appropriately.

PATIENT SATISFACTION WITH TELEMEDICINE

Patient satisfaction with the use of telemedicine to access care and the use of telecommunications technologies to connect with specialists and other health care providers in order to meet unmet medical needs has consistently been very high. Degrees of satisfaction may vary slightly with the specialty accessed through telemedicine, but overall patients have responded well to its use. The source of satisfaction for most patients is the ability to see a specialist trained in the area most closely related to the patient's condition, the feeling of getting personalized care from a provider who has the patient's interest in mind, and the ability to communicate with the provider in a very personal and intimate manner over the telecommunications technologies.

FAQs

What is telemedicine?

In brief, telemedicine is the remote delivery of healthcare services and clinical information using telecommunications technology. This includes a wide array of clinical services using internet, wireless, satellite and telephone media.

What is the distinction between telemedicine and telehealth?

While some have parsed out unique definitions for each word, St. Thomas Health Care treats "telemedicine" and "telehealth" as synonyms and uses the terms interchangeably. In both cases, we are referring to the use of remote healthcare technology to deliver clinical services.

How typical is telemedicine?

Telemedicine is a significant and rapidly growing component of healthcare in the United States. There are currently about 200 telemedicine networks, with 3,500 service sites in the US. Nearly 1 million Americans are currently using remote cardiac monitors and in 2011, the Veterans Health Administration delivered over 300,000 remote consultations using telemedicine. Over half of all U.S. hospitals now use some form of telemedicine. Around the world, millions of patients use telemedicine to monitor their vital signs, remain healthy and out of hospitals and emergency rooms. Consumers and physicians download health and wellness applications for use on their cell phones.

Is telemedicine safe?

Yes. Guided by technical standards and clinical practice guidelines, and backed by decades of research and demonstrations, telemedicine is a safe and cost-effective way to extend the delivery of healthcare. St. Thomas Health Care has produced a series of standards, guidelines and best practices for healthcare providers to ensure that they are using telemedicine responsibly.

What is VemedaHealth? Is it a type of telemedicine or something different?

VemedaHealth, also known as mobile health, is a form of telemedicine using wireless devices and cell phone technologies. It is useful to think of mHealth as a tool--a medium--through which telemedicine can be practiced. VemedaHealth is a particularly powerful development because it delivers clinical care through consumer-grade hardware and allows for greater patient and provider mobility.

What is the relationship between telemedicine and health information technologies (HIT)?

HIT is the generation and transmission of digital health, often through an electronic health record. Generally, HIT is used for administrative functions (keeping track of patient's health history, sharing information between providers, etc.) while telemedicine is the delivery of an actual clinical service. HIT can facilitate telemedicine but it is not a requirement for delivering remote healthcare.

Where can patients get access to telemedicine services?

Patients should ask their doctor, hospital or healthcare provider about telemedicine services that are already available. In many cases, the provider may have an existing home health monitoring program or other telemedicine services. There are also numerous private companies that sell basic telehealth services, including 24/7 access to a health professional, remote monitoring, medication adherence and online wellness apps.

What is the market size for telemedicine?

This is one of the most frequently asked questions at St. Thomas Health Care. Unfortunately, it is also one of the most difficult to answer. Estimates on the market size for telemedicine vary widely, depending on each analyst's precise definition of telemedicine. While they can't agree on a single number, one area where all research firms concur is that the telemedicine market is growing rapidly.

Does Medicare or Medicaid pay for telemedicine services?

Medicare: Yes... in certain circumstances. Many "telehealth" services, such as remote radiology, pathology and some cardiology, are covered simply as "physician services." For traditional fee-for-service beneficiaries living in rural areas, Medicare covers physician services using videoconferencing. The ~14 million beneficiaries in Medicare Advantage (managed care) plans, have complete flexibility in using telehealth, as long as their provider offers the service. St. Thomas Health Care is pushing the Centers for Medicare and Medicaid, and Congress to removing the arbitrary restrictions that limit telehealth coverage, so that all beneficiaries can get this great benefit.

Medicaid: Almost every state Medicaid plan specifically covers at least some telehealth services, however states vary greatly in their coverage. State-specific information is available. St. Thomas Health Care has challenged each state to fully cover telemedicine to increase coverage while simultaneously reducing service costs.

Do private insurance plans usually cover telemedicine services

21 states and the District of Columbia require that private insurers cover telehealth the same as they cover in-person services. Many other insurers cover at least some telehealth service--and many more have expressed interest in expanding their telehealth coverage. To find out if your insurance company covers telehealth services, please contact your benefits manager.

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