A Guide to Telemedicine
Medically reviewed on Nov 24, 2017 by L. Anderson, PharmD.
What Is Telemedicine?
New healthcare options called telemedicine and telehealth are rapidly becoming available for patients in the U.S. What is telemedicine? It’s a remote live and interactive communication, usually a type of online video chat, with a healthcare provider. For certain types of illnesses patients can be seen remotely using modern technology. Healthcare providers can often complete an exam, make a diagnosis, and even write a prescription for you, all from the comfort of your home.
Today, telemedicine is often used to treat patients with chronic diseases like high blood pressure, urgent care visits for coughs and colds, and to connect primary care physicians with medical specialists.
According to the American Telemedicine Association (ATA):
“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.”
Telemedicine had its first start over 40 years ago by hospitals to service rural and remote areas with limited healthcare access. Even astronauts routinely have their health monitored remotely. It’s not a separate medical specialty, but a way of delivering healthcare across the spectrum of medical services. However, not every office visit is amenable to telehealth. But for minor ailments or routine follow-ups, telemedicine is a reasonable, affordable, and often preferable option.
Today, as telemedicine is evolving, many private insurers are adopting rules to provide guidelines around how services are distributed and paid for. Many insurance companies, including will now pay for a remote telemedicine healthcare visit. Providers regularly use telehealth to visit with patients, often via call centers specifically for that purpose.
During a telemedicine consult, a healthcare provider such as a doctor, physician's assistant, nurse, or pharmacist meets with the patient via video conferencing to provide healthcare services. This may include the transmission of still images, use of electronic medical records, and patient portals, vital sign monitoring, health education, remote device monitoring, call center consults, and medication therapy management (MTM). The consult might take place on a computer, laptop, or even a wireless tablet. Special telemedicine software might be used in the session to gather vital data.
Common ailments you have that could easily be treated via telemedicine include:
- Back pain or problems
- Colds/sinus congestion
- Eye problems
- Ear infections
- Rash or other skin condition
- Some mental health counseling
Examples of Telemedicine
- Patient-direct health education such as proper use of an asthma inhaler device, groups sessions aimed at smoking cessation, or a follow-up visit with a new diabetes patient.
- Data, such as vital signs or still images, may be collected and forwarded for later review. Vital signs could include blood glucose levels, blood pressure, heart ECG, or other lab work. Still images might include an unusual mole, a picture of the inner ear, or a sore throat.
- Primary care doctors, such as pediatricians or family medicine doctors, can use telemedicine to provide a consult with a patient or another specialist doctor, like a board certified dermatologist, to help render a diagnosis. This may involve live, interactive video conferencing, still screen shots, or can be used in conjunction with a nurse-assisted visit. If needed, a patient may be immediately directed to schedule in-office care.
- Studies have evaluated the use of telemedicine in the emergency room setting to help patients with non-severe issues (common respiratory infections, cough, colds) be seen and discharged more quickly.
Telemedicine jobs are expected to increase as healthcare providers such as pharmacists, nurse practitioners, and physician assistants continue to expand in providing healthcare services and can serve as telemedicine providers.
The Status of Telemedicine Services
Health Affairs reports that telemedicine is set to grow at an annual rate of 50%, reaching $1.9 billion by 2018. There are over 200 telemedicine networks and 3,500 service sites in the U.S. In fact, over half of all U.S. hospitals now use some form of telemedicine. The Veterans Health Administration (VA) has delivered over 300,000 remote consultations using telemedicine. Technology and telemedicine companies now offer packages of cloud-based telehealth solutions for the healthcare industry. In addition, savvy healthcare consumers have access to many health and wellness applications for use on their mobile devices, often at the point of care.
Top telemedicine companies include:
- American Well
- Doctor On Demand
- LiveHealth Online
- Specialists On Call
Pharmacists are in a highly visible and patient-accessible role and should be integrated into telehealth solutions. Over 125,000 patients die each year due to medication non-adherence. This non-adherence - not taking a medication correctly, or simply not taking it at all - has led to health care costs approaching $105 billion. Telepharmacy, a branch of telemedicine conducted by a pharmacist, can help to address these costly, and often dangerous, outcomes.
Examples of Telepharmacy
- A patient might conference with a pharmacist to have a full overview of their medications two weeks after being discharged from the hospital. Side effects, dosing, cost, and other issues that lead to side effects or non-adherence can be reviewed. Medication therapy management (MTM) can prevent hospital readmission, dangerous side effects, and drug interactions.
- Remote pharmacists monitoring ICU patients in real time provide updates to hospital staff or a remote ICU team in areas such as medication dosing, antimicrobial coverage, and formulary support. Improved quality of patient care and cost reductions can be seen.
- At retail pharmacies and pharmacy health clinics, patients can access an off site healthcare provider via a kiosk providing telemedicine. Telemedicine is being used to increase access to healthcare providers in clinics such as Fred’s Pharmacy, CVS Minute Clinic and Rite Aid. Rite Aid’s pilot project in Ohio has engaged Cleveland Clinic staff clinicians.
- As reported in JAMA, a remote pharmacist can provide feedback to patients with uncontrolled hypertension based on real-time blood pressure monitoring. Patients engaged with the telemonitoring service were 90% more likely to have controlled blood pressure at 6- and 12-month intervals.
Studies have shown that access to a licensed pharmacist who provides pharmaceutical care can boost proper medication use, patient safety, and patient satisfaction.
Telemedicine Pros and Cons
The major benefits of telemedicine and telepharmacy seem obvious, but there are some hidden ones, too:
- Increased access to healthcare: Telemedicine can vastly increase the reach of healthcare providers. Rural areas, underserved populations, elderly patients or those without transportation can be helped. In addition, non-specialist healthcare providers can utilize telemedicine technology to consult with top specialists around the nation, or even the world. Overall, telemedicine can offer better scheduling options for increasingly busy doctors. Bad weather no longer becomes a factor if patients can access a healthcare provider online.
- Cost savings: Creating efficiencies in the use of time is essential in healthcare. This allows more patients to be seen. As noted by the ATA, telemedicine can reduce the cost of healthcare and increase efficiency through better management of chronic diseases, shared health professional staffing, reduced travel times, and fewer or shorter hospital stays. One study conducted in New York showed that telemedicine is a cost-effective way to replace more than a quarter of all visits to the emergency department. The group with access to telemedicine had 24 percent fewer ER visits, which cost about seven times the cost of a clinic or telemedicine visit.
- Improved Quality: Research has demonstrated that health care delivered via telemedicine has equal benefit to those visits conducted within a provider’s office. In fact, some specialties exceed the quality of an in-office visit, like mental health and ICU care. A medical home, where a team of healthcare providers work together to care for a patient, is an area where telemedicine has great benefit, too, especially if these healthcare providers do not work in the same medical office. Medical specialists can be accessed for consultation and recommendations for serious conditions, such as stroke.
- Better Patient Engagement: An important initiative within healthcare is increased patient engagement and having patients learn to take ownership for their acute, chronic and preventive healthcare. Telemedicine allows additional follow-up visits to be scheduled to encourage long-term engagement.
- Patient Demand: Patients want telemedicine; studies over the last 15 years have shown high rates of patient satisfaction. Using a smartphone, teleconferencing, and going wireless are everyday occurrences for the public today. Patients want to save driving time when possible, avoid sitting in a clinic of other sick patients, prevent work loss, and get themselves -- and their families - healthy.
Roadblocks to Telemedicine
It’s hard to imagine that there are roadblocks to such an exciting healthcare advance, but there are some major ones that are being addressed:
- Privacy and security: This may be the top concern that patients and healthcare providers have with telemedicine. As health groups choose vendors for telemedicine implementation, they must be sure to work with those that have a track record of HIPAA security. HIPAA guidelines need to be developed: 1. For healthcare providers who are involved with telemedicine. 2. For security surrounding video/audio recordings, and any EHR data, particularly when shared. 3. Added staff education on HIPAA laws should be instituted.
- Unavailability of services: While telehealth is expanding, it’s not available everywhere yet. With telemedicine services there has been concern as to how to handle state licensure issues when medicine is being shared between states through telecommunications. In addition, telemedicine reimbursement may or may not be covered. Patients should discuss with their insurance if telehealth services are available as covered benefit. Over half of the states now require that private insurers cover telehealth the same as they cover in-person services. Coverage with the government retiree program Medicare is an uphill battle, but some telehealth services are now covered under Medicare Part B.
- Concerns over increased utilization: There have been concerns that telemedicine could result in overutilization and overprescribing. Coordination of care will be essential to be sure the patient does not receive conflicting advice should they engage multiple doctors via telehealth. Controlled substances prescribing and potential “doctor shopping” for abusable prescription drugs are other areas where increased utilization may come into play.
- Pharmacist provider status: Pharmacists are also seeking provider status to allow adequate compensation for their highly accessible pharmaceutical care skills. Factors that would enable a broader reimbursement of pharmacists’ services include passage of the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592/S. 314)—which recognizes pharmacists and their services in Medicare Part B.
- Telemedicine reimbursement and other regulatory issues: While many healthcare insurers are adopting telemedicine with payment parity (paying healthcare providers equal to what they would receive with an in-office visit) reimbursements are still a debated area. Government agencies will want to see cost-savings studies, although Medicaid and Medicare now cover at least some telehealth services.
Telemedicine can never replace the human touch of your physician, nurse or pharmacist. In fact, telemedicine probably works best when used in conjunction with an established clinical provider relationship. But telemedicine makes good sense for many reasons. Now that greater access to telemedicine is occurring, significant cost savings and patient satisfaction are likely to be a bonus in the more widespread adoption of telemedicine.
- Herman B. Virtual reality: More insurers are embracing telehealth. Modern Healthcare. February 20, 2016. Accessed Nov. 24, 2017 at http://www.modernhealthcare.com/article/20160220/MAGAZINE/302209980
- Medicare.gov. Telehealth. Accessed Nov. 24, 2017 at https://www.medicare.gov/coverage/telehealth.html
- Rural Kids Face Special Challenges When Seriously Ill: Study. Drugs.com. April 11, 2016. Accessed Nov. 24, 2017 at https://www.drugs.com/news/rural-kids-face-special-challenges-seriously-ill-study-60834.html.
- Sweeny E. How Partners Healthcare is using virtual care. FierceHealthcare. December 12, 2016. Accessed Nov. 24, 2017 at http://www.fiercehealthcare.com/it/3-ways-brigham-and-women-s-hospital-using-virtual-care.
- North Carolina Health News. Medicare Slow to Adopt Telemedicine Due to Cost Concerns. July 2, 2015. Accessed Nov. 24, 2017 at http://www.northcarolinahealthnews.org/2015/07/02/medicare-slow-to-adopt-telemedicine-due-to-cost-concerns/
- Meidl T, Woller T, Iglar A, et al. Implementation of pharmacy services in a telemedicine intensive care unit. American Journal of Health-System Pharmacy. August 1, 2008;65:1464-69. Accessed Nov. 24, 2017 at http://www.ncbi.nlm.nih.gov/pubmed/18653818
- American Telemedicine Association. Telemedicine Practice Guidelines. Accessed Nov. 24, 2017 at http://www.americantelemed.org/resources/telemedicine-practice-guidelines/telemedicine-practice-guidelines
- Telemedicine a Cost-Effective Alternative to ER Visits. Drugs.com. May 9, 2008. Accessed Nov. 24, 2017 at https://www.drugs.com/news/telemedicine-cost-effective-alternative-er-visits-12117.html
- Kosowsky J. Pharmacy Times. The Potential for Telehealth Within the Pharmacy Space. August 20, 2015. Accessed Nov. 24, 2017 at http://www.pharmacytimes.com/publications/directions-in-pharmacy/2015/august2015/the-potential-for-telehealth-within-the-pharmacy-space
- Margolis KL, Asche SE, Bergdall AR, et al. Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. JAMA. 2013;310(1):46–56. Accessed Nov. 24, 2017 at http://jama.jamanetwork.com/article.aspx?articleid=1707720