Beginner's Quick Reference Guide to Telehealth & Telemedicine

July 1, 2020

With telemedicine’s increasing prevalence and importance, we have made an extensive overview of telemedicine and summarized its key elements. Whether you are a healthcare provider or a patient looking to know more, this overview should answer many questions. We at Eko are passionate about healthcare and create digital health solutions that enable doctors, nurses, researchers, and entire health systems to evolve the way they practice medicine. Eko’s AI-powered software and smart medical devices allow clinicians to practice telemedicine safely and effectively. Our team is here to support you; if you have any questions about telemedicine, please contact our team.

Table of contents:
  1. What telemedicine is and its history
  2. The difference between telemedicine and telehealth 
  3. The benefits and advantages of telemedicine
  4. Telemedicine and the triple aim of healthcare
  5. Telemedicine glossary
  6. Telemedicine technology and equipment list overview
  7. Specialties that telemedicine supports 
  8. Telemedicine reimbursement & funding
  9. Future of telemedicine
  10. Telemedicine resources


What is Telemedicine

Telemedicine refers to the practice of caring for patients remotely when the provider and patient are not physically present with each other. Physicians and patients can share information in real-time through software which allows patients to receive a diagnosis and treatment from a doctor, right from the comfort of their own home! The benefits of telemedicine have been detailed during COVID-19, and telemedicine is here to stay as a permanent and prominent part of the healthcare system because of its accessibility, cost-effectiveness, and safety.

Telemedicine began early in the 19th century; it began as the use of the telephone to reduce unnecessary office visits, then it expanded to physicians being able to transmit neurological examinations using two-way interactive television. Today, telemedicine allows clinicians to monitor everything from a patient’s lung sounds to glucose levels through home-use medical devices. Telemedicine allows providers to limit unnecessary office visits and facilitate check-ins, screenings, and diagnostics all from the comfort of the patient’s home. 


Difference Between Telehealth and Telemedicine

Telehealth and telemedicine are often used interchangeably, but they actually refer to different things. 

Telemedicine

Telemedicine refers to the practice of caring for patients remotely when the provider and patient are not physically present with each other. Telemedicine uses telecommunications technology and information technologies to provide remote clinical services to patients. Physicians use telemedicine for the transmission of digital imaging, video consultations, and remote medical diagnosis.

Telehealth

Although telehealth is similar to telemedicine, telehealth is much broader because it covers non-clinical events. Telehealth is defined as the distribution of health-related services and information via electronic information and telecommunication technologies.[1] It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions.

Benefits of Telemedicine 

For providers
  • Better assistance in diagnosis and treatment: Technologies that come integrated with telemedicine software like electronic medical records, AI diagnosis, and medical streaming devices allow a provider to diagnose and treat a patient more effectively.
  • Improved efficiency: Telemedicine also allows providers to see more patients without the need to hire more staff or get a larger office space. By increasing efficiency, providers can benefit from increased revenue
  • Less exposure to illness and infections: Telemedicine reduces the spread of infection by keeping patients away from others such as patients and health care providers. 


For patients
  • Improved access to care: Telemedicine allows patients that had limited access to healthcare to see a physician without leaving their home. Patients with disabilities, older adults, and geographically isolated people can receive care with ease. 
  • Advanced medicine with familiar technology: Now that the world is digital, it is time for medicine to adapt at the same level. Anyone that has used Skype or Zoom before will feel familiar and at ease communicating with their provider through telemedicine. When older generations that are less familiar with technological platforms adopt telemedicine, they will be able to use it at their own convenience and at their own comfort level. 
  • Lower costs: According to one study, 93% of healthcare providers that use telemedicine say it reduces their costs. One study showed the average cost of a telemedicine appointment is $39, or about one-third less than the traditional visit.
  • Convenience: Telemedicine allows people to access care in the comfort and privacy of their own homes. This means that patients do not have to spend time traveling to an appointment or waiting in traffic. They also may not have to miss work to attend their appointments since they can schedule an appointment during a work break or after work.
  • Reduced spread of disease: Telemedicine eliminates the risk of picking up and infection at the doctor’s office, keeping those with underlying conditions and weak immune systems safe and healthy. 

Telemedicine and the Quadruple Aim of Healthcare 

What used to be the triple aim is now the quadruple aim: an approach to healthcare that seeks to optimize health system performance. The strategy is a single aim with four dimensions. 

1. Patient satisfaction

Patient satisfaction is commonly defined in terms of improving patient quality and experience in healthcare, and telemedicine scores consistently high for patient satisfaction by providing and giving access to care when patients need it and limiting their exposure to disease. 

2. Patient outcome

Telemedicine achieves patient outcomes by allowing for timely care and early detection which improves population health. Moreover, telemedicine allows health care organizations to not only improve their population health but geographic population health as well. 


3. Reduced costs of providing healthcare

Telemedicine reduces clinical overhead costs while improving the patient’s time and money invested in the appointment. Patients can avoid unnecessary costs of unnecessary hospital readmissions, emergency department visits, and ambulance transfers, and healthcare providers can staff and schedule more efficiently and flexibly provide after-hours care 

4. Provider experience

The emerging quadruple aim is provider experience; telemedicine makes it easy and efficient for clinicians to provide high-quality care for their patients from afar, and the effect is that providers have a better experience and in turn are less likely to burn out. 

Interested in practicing telemedicine? Visit our telehealth page to learn more.

Glossary of Telemedicine Terms

We consolidated all telemedicine terms and definitions from industry sites to give you an easy to read glossary.

  1. API (Application Programming Interface) An API is software that sets the rules for two applications to send data between them. APIs are used in medical practices to connect telemedicine technology to electronic health record systems, online scheduling applications, or practice management systems. This eliminates the need for duplicate data entry and reduces potential errors.
  1. Application Service Provider (ASP): An ASP hosts a variety of applications on a central server. For a fee, customers can access the applications that interest them over secure Internet connections or a private network. This means that they do not need to purchase, install and maintain the software themselves; instead they rent the applications they need from their ASP. Even new releases, such as software upgrades, are generally included in the price.
  1. Asynchronous: This term is sometimes used to describe store and forward transmission of medical images or information because the transmission typically occurs in one direction in time. This is the opposite of synchronous (see below).
  2. Audio-teleconferencing: Audio-teleconferencing is simply a phone call between two or more parties. Visits using audio-teleconferencing without a video component are usually not covered by insurance.
  1. Authentication: A method of verifying the identity of a person sending or receiving information using passwords, keys and other automated identifiers.
  1. Bandwidth: A measure of the information carrying capacity of a communications channel; a practical limit to the size, cost, and capability of a telemedicine service.
  1. Bluetooth Wireless: Bluetooth is an industrial specification for wireless personal area networks (PANs). Bluetooth provides a way to connect and exchange information between devices such as mobile phones, laptops, PCs, printers, digital cameras and video game consoles over a secure, globally unlicensed short-range radio frequency. The Bluetooth specifications are developed and licensed by the Bluetooth Special Interest Group.
  1. Broadband: Communications (e.g., broadcast television, microwave, and satellite) capable of carrying a wide range of frequencies; refers to transmission of signals in a frequency-modulated fashion, over a segment of the total bandwidth available, thereby permitting simultaneous transmission of several messages.
  1. Clinical Information System: Relating exclusively to the information regarding the care of a patient, rather than administrative data, this hospital-based information system is designed to collect and organize data.
  1. CODEC: Acronym for coder-decoder. This is the videoconferencing device (e.g., Polycom, Tandberg, Sony, Panasonic, etc) that converts analog video and audio signals to digital video and audio code and vice versa. CODECs typically compress the digital code to conserve bandwidth on a telecommunications path.
  1. Compressed video: Video images that have been processed to reduce the amount of bandwidth needed to capture the necessary information so that the information can be sent over a telephone network. 
  1. Computer-based Patient Record (CPR): An electronic form of individual patient information that is designed to provide access to complete and accurate patient data.
  1. Data Compression: A method to reduce the volume of data using encoding to reduce image processing, transmission times, bandwidth requirements, and storage space requirements. Some compression techniques result in the loss of some information, which may or may not be clinically important.
  1. Diagnostic Equipment (Scopes, Cameras & Other Peripheral Devices): A hardware device not part of the central computer (e.g. digitizers, stethoscope, or camera) that can provide medical data input to or accept output from the computer.
  1. Digital Camera (still images): A digital camera is typically used to take still images of a patient. General uses for this type of camera include dermatology and wound care. This camera produces images that can be downloaded to a PC and sent to a provider/consultant over a network.
  1. Digital Imaging and Communication in Medicine (DICOM): A standard for communications among medical imaging devices; a set of protocols describing how images are identified and formatted that is vendor-independent and developed by the American College of Radiology and the National Electronic Manufacturers Association.
  1. Disease Management: A continuous coordinated health care process that seeks to manage and improve the health status of a carefully defined patient population over the entire course of a disease (e.g., CHF, DM) The patient populations targeted are high-risk, high-cost patients with chronic conditions that depend on appropriate care for proper maintenance.
  1. Distance Learning: The incorporation of video and audio technologies, allowing students to “attend” classes and training sessions that are being presented at a remote location. Distance learning systems are usually interactive and are a tool in the delivery of training and education to widely dispersed students, or in instances in which the instructor cannot travel to the student’s site.
  1. Distant Site: The distant site is defined as the telehealth site where the provider/specialist is seeing the patient at a distance or consulting with a patient’s provider. (CMS) Others common names for this term include – hub site, specialty site, provider/physician site and referral site. The site may also be referred to as the consulting site.
  1. Document Camera: A camera that can display written or typed information (e.g., lab results), photographs, graphics (e.g., ECG strips) and in some cases x-rays.
  1. Electronic Data Interchange (EDI): The sending and receiving of data directly between trading partners without paper or human intervention.
  1. Electronic Patient Record: An electronic form of individual patient information that is designed to provide access to complete and accurate patient data, alerts, reminders, clinical decision support systems, links to medical knowledge, and other aids.
  1. Encryption: A system of encoding data on a Web page or e-mail where the information can only be retrieved and decoded by the person or computer system authorized to access it.
  1. Firewall: Computer hardware and software that block unauthorized communications between an institution’s computer network and external networks.
  1. Full-motion Video: This describes a standard video signal that allows video to be shown at the distant end in smooth, uninterrupted images.
  1. Guideline: A statement of policy or procedures by which to determine a course of action, or give guidance for setting standards (Loane & Wootton, 2002).
  1. H.320: This is the technical standard for videoconferencing compression standards that allow different equipment to interoperate via T1 or ISDN connections.
  1. H.323: This is the technical standard for videoconferencing compression standards that allow different equipment to interoperate via the Internet Protocol (see below).
  1. H.324: This is the technical standard for videoconferencing compression standards that allow different equipment to interoperate via Plain Old Telephone Service (POTS).
  1. Health Level-7 Data Communications Protocol (HL-7): This communication standard guides the transmission of health-related information. HL7 allows the integration of various applications, such as bedside terminals, radiological imaging stations, hospital census, order entries, and patient accounting, into one system.
  1. HIPAA (Health Insurance Portability and Accountability Act) HIPAA is United States legislation, enacted in 1996, that provides data privacy and security provisions for safeguarding medical information. HIPAA is important to telemedicine because its Privacy Rule and Security Rule govern how providers and their business associates must protect the confidential health information of patients.
  1. Home Health Care & Remote Monitoring Systems: Home health care is care provided to individuals and families in their place of residence for promoting, maintaining, or restoring health; or for minimizing the effects of disability and illness, including terminal illness. In the Medicare Current Beneficiary Survey and Medicare claims and enrollment data, home health care refers to home visits by professionals including nurses, physicians, social workers, therapists, and home health aides. Using remote monitoring and interactive devices allows the patient to send in vital signs on a regular basis to a provider without the need for travel.
  1. In-band signaling or streaming: In telemedicine, in-band signaling is when data, such as stethoscope audio it transferred within the same band or channel used for data such as voice or video.
  1. Informatics: The use of computer science and information technologies to the management and processing of data, information and knowledge.
  1. Integrated Services Digital Network (ISDN): This is a common dial-up transmission path for video conferencing. Since ISDN services are used on demand by dialing another ISDN based device, per minute charges accumulate at some contracted rate and then are billed to the site placing the call. This service is analogous to using the dialing features associated with a long distance telephone call. The initiator of the call will pay the bill. ISDN permits connections up to 128Kbps.
  1. Interactive Video/Television: This is analogous with video conferencing technologies that allow for two-way, synchronous, interactive video and audio signals for the purpose of delivering telehealth, telemedicine or distant education services. It is often referred to by the acronyms – ITV, IATV or VTC (video teleconference).
  1. Internet Protocol: The Internet Protocol (IP) is the protocol by which data is sent from one computer to another on the Internet. Each computer on the Internet has at least one address that uniquely identifies it  from all other computers on the Internet. IP is a connectionless protocol, which means that there is no established connection between the end points that are communicating. The IP address of a videoconferencing system is its phone number.
  1. Interoperability: Interoperability refers to the ability of two or more systems* to interact with one another and exchange information in order to achieve predictable results (*refers to more than technical systems) (Bergman, Ulmer and Sargious, 2001). There are three types of interoperability: human/operational; clinical; and technical (Canadian Society for Telehealth, 2001). Interoperability refers to the ability of two or more systems (computers, communication devices, networks, software, and other information technology components) to interact with one another and exchange data according to a prescribed method in order to achieve predictable results (ISO ITC-215).
  1. ISDN Basic Rate Interface (BRI): This is an ISDN interface that provides 128k of bandwidth for videoconferencing or simultaneous voice and data services. Multiple BRI lines can be linked together using a multiplexer (see below) to achieve higher bandwidth levels. For instance, a popular choice among telehealth networks is to combine 3 BRI lines to provide 384k of bandwidth for video-conferencing. It should be noted that BRI services are not available in some rural locations. One should check with their telecommunications providers on the availability of BRI service before ordering videoconferencing equipment that uses this type of service.
  1. ISDN Primary Rate Interface (PRI): This is an ISDN interface standard that operates using 23, 64k channels and one 64k data channel. With the proper multiplexing equipment the ISDN PRI channels can be selected by the user for a video call. For instance if the user wants to have a videoconference at 384k of bandwidth then they can instruct the multiplexer to use channels 1 through 6 (6 x 64k = 384k). This is important because the user typically pays charges based on the number of 64k channels used during a videoconference. The fewer channels used to obtain a quality video signal the less expensive the call.
  1. JCAHO: Acronym for Joint Commission on Accreditation of Healthcare Organizations.
  1. Lossless: A format of data compression, typically of an order of less than 2:1, in which none of the original data information is lost when the image is reproduced.
  1. Lossy: A process of data compression at a relatively high ratio, which leads to some permanent loss of information upon reconstruction.
  1. Medical/ Nursing Call Center: A call center is a centralized office that answers incoming telephone calls from patients. Such an office may also respond to letters, faxes, e-mails and similar written correspondence. Usually staffed by nurses, call centers provide basic health information and instructions to callers but do not provide an official diagnosis of conditions or prescribe medicine. Call centers act as an initial triage point for patients.
  1. Mobile Telehealth: The provision of health care services with the assistance of a van, trailer, or other mobile unit in which the health care provider might provide patient services at a distance from a normal medical facility. Services may also be provided through mobile technologies that allow a mobile vehicle equipped with medical technologies to attach to an existing health care facility, such as mobile CT, MRI, or TeleDentistry.
  1. Multiplexer (MUX): A device that combines multiple inputs (ISDN PRI channels or ISDN BRI lines) into an aggregate signal to be transported via a single transmission path.
  1. Multi-point Control Unit (MCU): A device that can link multiple videoconferencing sites into a single videoconference. An MCU is also often referred to as a “bridge”.
  1. Multi-point Teleconferencing: Interactive electronic communication between multiple users at two or more sites which facilitates voice, video, and/or data transmission systems: audio, graphics, computer and video systems. Multi-point teleconferencing requires a MCU or bridging device to link multiple sites into a single videoconference.
  1. Network Integrators: Organizations specializing in the development of software and related services that allows devices and systems to share data and communicate to one another.
  1. Originating Site: The orginating site is where the patient and/or the patient’s physician is located during the telehealth encounter or consult (CMS). Other common names for this term include – spoke site, patient site, remote site, and rural site.
  1. Out-of-band signaling or streaming: In telemedicine, out-of-band signaling is when data, such as stethoscope audio, is transferred in a separate channel than voice or video. Out-of band streaming can lead to higher quality fidelity.
  1. Patient Exam Camera (video): This is the camera typically used to examine the general condition of the patient. Types of cameras include those that may be embedded with set-top videoconferencing units, handheld video cameras, gooseneck cameras, camcorders, etc. The camera may be analog or digital depending upon the connection to the videoconferencing unit.
  1. Peripheral Devices: Any device that is attached to a computer externally, i.e. Scanners, mouse pointers, printers, keyboards; and clinical monitors such as pulse oximeters, weight scales, are all examples of this.
  2. Pharmacy Solutions: The use of electronic information and communication technology to provide and support comprehensive pharmacy services when distance separates the participants.
  1. POTS: Acronym for Plain Old Telephone Service.
  1. Presenter (Patient Presenter): Telehealth encounters require the distant provider to perform an exam of a patient from many miles away. In order to accomplish that task an individual with a clinical background (e.g., LPN, RN, etc) trained in the use of the equipment must be available at the originating site to “present” the patient, manage the cameras and perform any “hands-on” activities to successfully complete the exam. For example, a neurological diagnostic exam usually requires a nurse capable of testing a patient’s reflexes and other manipulative activities. It should be noted that in certain cases, such as interview based clinical consultations such as Telemental Health or Nutrition Services, that a licensed practitioner such as an RN or LPN, might not be necessary, and a non-licensed provider such as support staff, could provide telepresenting functions.
  1. RHIO: Regional Health Information Organization (RHIO) and Health Information Exchange (HIE) are often used interchangeably. RHIO is a group of organizations with a business stake in improving the quality, safety, and efficiency of healthcare delivery. RHIOs are the building blocks of the proposed National Health Information Network (NHIN) initiative at the Office of the National Coordinator for Health Information Technology (ONCHIT).
  1. Router: This device provides an interface between two networks or connects sub-networks within a single organization. It routes network traffic between multiple locations and it can find the best route between any two sites. For example, PCs or H.323 videoconferencing devices tell the routers where the destination device is located and the routers find the best way to get the information to that distant point.
  1. SaaS (Software as a Service) SaaS is a method of delivering software in which the software resides on hardware controlled by the vendor. Users access it via a web browser or mobile application. This method of software delivery puts the onus of maintenance on the vendor, rather than the customer and reduces the time and cost it takes to get started. You may hear this referred to as cloud-based, or internet-based software.
  1. Standard: A statement established by consensus or authority, that provides a benchmark for measuring quality, that is aimed at achieving optimal results (NIFTE Research Consortium, 2003).
  1. Store and Forward (S&F): S&F is a type of telehealth encounter or consult that uses still digital images of a patient for the purpose of rendering a medical opinion or diagnosis. Common types of S&F services include radiology, pathology, dermatology and wound care. Store and forward also includes the asynchronous transmission of clinical data, such as blood glucose levels and electrocardiogram (ECG) measurements, from one site (e.g., patient’s home) to another site (e.g., home health agency, hospital, clinic).
  1. Switch: A switch in the videoconferencing world is an electrical device that selects the path of the video transmission. It may be thought of as an intelligent hub (see hub above) because it can be programmed to direct traffic on specific ports to specific destinations. Hub ports feed the same information to each device.
  1. Synchronous: This term is sometimes used to describe interactive video connections because the transmission of information in both directions is occurring at exactly the same period.
  1. System/Network Integration: The use of software that allows devices and systems to share data and communicate to one another.
  1. T1/DS1: A digital carrier or type of telephone line service offering high-speed data, voice, or compressed video access in two directions, with a transmission rate of 1.544 Mbps.
  1. T3/DS3: A carrier of 45 Mbps.
  1. TCP/IP (Transmission Control Protocol/Internet Protocol): The underlying communications rules and protocols that allow computers to interact with each other and exchange data on the Internet.
  1. Telecommunications Providers: An entity licensed by the government (the Federal Communications Commission in the U.S.) to provide telecommunications services to individuals or institutions.
  1. Teleconferencing: Interactive electronic communication between multiple users at two or more sites which facilitates voice, video, and/or data transmission systems: audio, graphics, computer and video systems.
  1. Telehealth and Telemedicine: Telemedicine and telehealth both describe the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status. Although evolving, telemedicine is sometimes associated with direct patient clinical services and telehealth is sometimes associated with a broader definition of remote healthcare services.
  1. Telematics: The use of information processing based on a computer in telecommunications, and the use of telecommunications to permit computers to transfer programs and data to one another.
  1. Telementoring: The use of audio, video, and other telecommunications and electronic information processing technologies to provide individual guidance or direction. An example of this help may involve a consultant aiding a distant clinician in a new medical procedure.
  1. Telemonitoring: The process of using audio, video, and other telecommunications and electronic information processing technologies to monitor the health status of a patience from a distance.
  1. Telepresence: The method of using robotic and other instruments that permit a clinician to perform a procedure at a remote location by manipulating devices and receiving feedback or sensory information that contributes to a sense of being present at the remote site and allows a satisfactory degree of technical achievement. For example, this term could be applied to a  surgeon using lasers or dental hand pieces and receiving pressure similar to that created by touching a patient so that it seems as though s/he is actually present, permitting a satisfactory degree of dexterity.
  1. Teleradiology and Picture Archiving and Communications Systems (PACs): The electronic transmission of radiological images, such as x-rays, CTs, and MRIs, for the purposes of interpretation and/or consultation. Digital images are transmitted over a distance using standard telephone lines, satellite connections, or local area networks (LANs). Teleradiology also is beginning to include the process of interfacing with the hospital information systems/radiology information systems (HIS/RIS) in the transport of digital images. PACs provide centralized storage and access to medical images over information system.
  1.  Ultrasound: A device that uses high-frequency sound waves to examine structures inside the body. It can rapidly detect tumors and other abnormalities, often right in the physician’s office.
  1. Universal Service Administrative Company (USAC): The Universal Service Administrative Company administers the Universal Service Fund (USF), which provides communities across the country with affordable telecommunication services. The Rural Health Care Division (RHCD) of USAC manages the telecommunications discount program for health care.
  1.  Video Conferencing Systems: Equipment and software that provide real-time, generally two way transmission of digitized video images between multiple locations; uses telecommunications to bring people at physically remote locations together for meetings. Each individual location in a videoconferencing system requires a room equipped to send and receive video.
  1. Videoconferencing: Real-time, generally two way transmission of digitized video images between multiple locations; uses telecommunications to bring people at physically remote locations together for meetings. Each individual location in a videoconferencing system requires a room equipped to send and receive video.
  1. WiFi: Originally licensed by the Wi-Fi Alliance to describe the underlying technology of wireless local area networks (WLAN) based on the IEEE 802.11 specifications. It was developed to be used for mobile computing devices, such as laptops, in LANs, but is now increasingly used for more services, including Internet and VoIP phone access, gaming, and basic connectivity of consumer electronics such as televisions and DVD players, or digital cameras. (Wikipedia)


Telemedicine Technology and Equipment

We have compiled a comprehensive list of telemedicine technology and equipment. Some practices may use all or some of the items listed below depending on the specialty.

Telemedicine Cart

This piece of telemedicine equipment gives providers a mobile frame and storage system to carry cameras, computers monitors, keyboards, computers, and mobile medical devices. The carts sometimes look similar to standing work desks, with computer monitors attached at the top and wheels at the bottom for easy moving. Physicians can wheel these carts from room-to-room as they meet with patients and need to either record and transmit a patient’s medical data, or include a consulting physician from another location in the patient visit.”

Telemedicine Kiosk

These kiosks look a little like photobooths, and are usually stocked with all the equipment and commonly used mobile medical devices needed for a telemedicine visit. These kiosks are expensive and often only purchased by large companies or retail clinics to extend healthcare offerings to employees and pharmacy customers.

Telemedicine Kit

These kits may include a small computer with an integrated screen, a camera, and simple mobile medical devices and peripherals. Telemedicine cameras facilitate face to face interaction with patients and serve as a diagnostic tool such as in tele-dermatology. Components of a telemedicine video conferencing system vary, depending on the configuration chosen by the buyer, and most suppliers offer different configurations customized to the buyer’s needs.

Telemedicine Diagnostic & Peripheral Devices 

Peripheral devices for a normal computer are mouse pointers, keyboards, video camera, scanner, however, peripheral devices for telemedicine are weight scales, pulse oximeters, stethoscopes, otoscopes, and blood pressure cuffs. 

  • Stethoscope - digital stethoscopes allow for remote healthcare providers to receive and listen to real-time sounds from their patient equivalent or better than those at the point of care.  
  • Otoscope - used in telemedicine applications to perform pneumatic otoscope exams in order to obtain an exceptionally clear view of the out-ear canal, eardrum and middle ear.
  • Blood pressure cuffs - used by a patient in blood pressure telemonitoring (BPT) which allows the clinicians to track the patient’s blood pressure and general health status all from the comfort of the patient’s home. 
  • Weight scale- can be used by patients who are weight-conscious or who have heart conditions in order that a provider can measure and track their information. 
  • Pulse oximeter- used in telemedicine to measure and monitor the saturation level of oxygen in a patient’s blood and their pulse rate. This information can be sent to a provider to analyze. 


Specialties that Telemedicine Supports

Tele-endocrinology

Endocrinologists can virtually treat osteoporosis, arthritis, diabetes, and other diseases related to the endocrine glands and hormones.


Tele-cardiology

Cardiologists review electrocardiogram recordings to remotely diagnose and treat congenital heart conditions, cardiovascular disease, arrhythmias, and other heart conditions. Patient ECG data is remotely sent to the doctor in real-time via a secure connection with the help of an on-site healthcare professional. Equipment like digital stethoscopes, exam cameras, and EKGs make this possible.


Tele-gynecology

Gynecologists provide obstetrics and gynecological care for women’s health patients by reviewing test results, monitoring symptoms and medication plans, and delivering post-operative care via remote technology. Tele-OB/GYN visits can’t fully take the place of on-site appointments, but they do make care in between visits more convenient and frequent. Specific conditions that tele-gynecology is particularly viable for include postpartum depression, gestational diabetes, hypertension, and preeclampsia. Obstetrics and gynecology providers can also provide family planning services to their patients via telemedicine.

Tele-radiology

Remote radiologists analyze and interpret MRIs, CT scans, and x-ray images sent electronically, eliminating the need for low-volume hospitals to continually staff radiology professionals and providing flexibility for the remote practitioner.


Tele-neurology

Neurologists remotely diagnose and treat neurological problems including headaches, dementia, strokes, multiple sclerosis, and epilepsy. Tele-neurologists often provide remote care to inpatient or emergency patients as a response to stroke, seizure, and other emergency neurological conditions with the aid of on-site healthcare professionals.


Tele-psychiatry

Tele-psychiatry can involve providing a range of services including psychiatric evaluations, therapy (individual therapy, group therapy, family therapy), patient education and medication management. Tele-psychiatry can involve direct interaction between a psychiatrist and the patient. It also encompasses psychiatrists supporting primary care providers with mental health care consultation and expertise. Mental health care can be delivered in a live, interactive communication. It can also involve recording medical information (images, videos, etc.) and sending this to a distant site for later review.


Tele-oncology

Tele-oncology, the application of telemedicine technology to cancer care delivery, is helping patients in any geographic location access high-quality treatment from oncologists and top specialists without the need to travel or wait for an appointment despite predicted physician shortages. Patients in the 70 percent of U.S. counties without an oncologist can benefit from the increased convenience of receiving treatment that was previously unavailable or too challenging to access. Included among the strategies showing the most promise are telegenetics, the bundling of cancer-related teleapplications, remote chemotherapy supervision, symptom management, survivorship care, palliative care, and efforts to increase access to cancer clinical trials.

Telemedicine Reimbursement & Funding

There are four primary buckets of funding and reimbursement for telemedicine.

  1. Medicare
  2. Medicade
  3. Private insurance
  4. Grant funding
Reimbursement

Telemedicine reimbursement varies a lot depending on state, practice, services, and the third party payer. We summarized the three buckets of reimbursement: Medicare, Medicaid, and private insurance. This information is a general outline, and we recommend working with a billing expert to understand what is best for your practice.


Medicare:

Medicare reimburses for telehealth and telemedicine services offered by a healthcare provider at a distant site, to a Medicare beneficiary (the patient) at an originating site. The originating site must be in a HPSA (Health Professional Shortage Area).  The types of originating sites authorized by law are:

  • Physicians or practitioner offices
  • Hospitals
  • Critical Access Hospitals (CAH)
  • Rural Health Clinics
  • Federally Qualified Health Centers
  • Hospital-based or CAH-based Renal Dialysis Centers
  • Skilled Nursing Facilities (SNF)
  • Community Mental Health Centers (CMHC)

Medicare has a specific list of CPT and HCPCS codes that are covered under telemedicine services. Since that list is subject to change each year, we also recommend you check the CMS website.


Medicaid:

Telehealth and telemedicine reimbursement policies vary from state to state and looking up Medicaid telemedicine reimbursement laws in your desired state crucial. https://www.cchpca.org/telehealth-policy/telehealth-medicaid-and-state-policy

Private:

The largest commercial payers do cover telemedicine. However, whether they will reimburse for a telemedicine service is policy-dependent, meaning one patient might be covered under their BCBS policy and another may not if their policy excludes telemedicine.  The best way to find out telemedicine reimbursement policies from your private payers is to pick up the phone and call their eligibility and benefits department, and have a list of the relevant telemedicine CPT codes on hand see Complete Telemedicine Reimbursement Guide


Grant Funding

Telemedicine is emerging quickly as the future of healthcare, and because of its impact on the fight against COVID-19, there are many opportunities for grant funding. To support the rapid expansion of telemedicine, reimbursement rules for telemedicine are evolving, and government agencies are opening up new funding opportunities for health systems. There is a $200 million grant from the CARES act. Learn more about telemedicine grants here https://www.ekohealth.com/blog/telehealth-grants-funding


Future of Telemedicine

Since COVID-19 started, patient volume has fallen by an average of 60% for medical practices. Emergency rooms have reported a dramatic drops in visits, especially those that are critical to a patient living or dying. Before COVID-19, walking into a clinic or emergency room was not something people thought could put their health further at risk. Within weeks of the outbreak, telemedicine providers reported dramatic increase in the use of telemedicine services. Telemedicine is seeing an incredible increase in reimbursement and funding which solidifies the fact telemedicine is here to stay. 

We predict these trends:

1. More Convenient and Mainstream

Telemedicine’s convenience and access will be two major drivers for the future. Doctors will be more comfortable with virtual care, and patients and families will prefer it.  Additionally, virtual visits will be key for urban and rural areas where people may not have access to necessary healthcare, and population-based reimbursements will offer an alternative to costly in-person healthcare. At-home behavioral health services will widely replace in-office or emergency room visits, and Medical societies will support a blending of in-person and virtual visits for ongoing care.

2. Healthcare will be Omnichannel 

Omnichannel Companies are those that combine the internet, stores and catalogs with a seamless experience so consumers can shop how they want and when they want. Healthcare is developing this same approach through telemedicine to give patients the same quality care and experience whether they are in a clinic, at-home or virtual.

3. Telemedicine will Rely on Artificial Intelligence (AI)

AI and machine learning tools will continue to help physicians make more informed decisions and patients receive better care. Connor Landgraf, CEO of Eko, says that “AI stands to be the tipping point for many providers who are currently wary of virtual care.” AI can empower providers to make better and easier diagnoses. While it is clear that AI will not replace clinicians, it will complement and help to close gaps in healthcare to drive a new era of personalized medicine. 


Telemedicine Resources

Telemedicine practices, technology, and policy is rapidly evolving. Below are helpful resources to with both national and regional support for individual practitioners and health systems.

The American Telemedicine Association is the national association with the sole focus of accelerating the adoption of telehealth. We find their online forum to be a great resource. Learn more at https://www.americantelemed.org/

The National Consortium of Telehealth Resource Centers (NCTRC) is a collaborative of 12 regional and 2 national Telehealth Resource Centers (TRCs), committed to implementing telehealth programs for rural and underserved communities. We work get support directly from their regional staff and conferences. Learn more at https://www.telehealthresourcecenter.org/

We are proud to offer health systems 30-days complimentary Eko Telehealth access. Visit our Telemedicine page to learn more.

Read More Telehealth Articles

How Telehealth is used to Treat HIV in Rural Alabama

Eko Telemedicine for COVID-19 Response

Video Overview of In-Clinic & At-Home Telemedicine

Case Studies & Example Telemedicine Deployments

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