A Comprehensive Guide to Telemedicine
An important step in providing timely and effective care for patients with medical conditions is figuring out the most effective and efficient way to do so. It used to be that patients who needed to see a doctor for any reason had to make an appointment over the phone and travel to a physical location, wait in the waiting room, and then wait in the examination room. After this, they were required by the doctor’s office to hand deliver a written note to the pharmacy, and then return later to pick up the prescription. In some cases, given the complicated nature of seeking treatment for an ailment in this model, patients may choose to avoid going to the doctor if they only have a minor complaint, especially if they live in a remote area and getting to a medical facility is inconvenient. This may necessitate further referrals to specialist doctors, which would result in an additional cost for an office visit.
The emergence of telehealth in the healthcare system is traceable back to the need to address the problem of optimizing patient and provider time and ability to communicate, even if separated by distance. Patients with minor complaints who might not require a visit to the doctor’s office can now be contacted via the internet, allowing the medical profession to streamline this process and reach out to those who are homebound or too remote to visit a doctor’s office. Patients can receive long-distance health care from doctors and nurses who use digital technology and the most recent advancements in telecommunications to communicate with each other and serve their needs. As technology advances, so does the practice, which has progressed considerably since its inception.
Telemedicine (TM): A Brief History
The history of telemedicine is longer than you would think, with first telehealth visits were conducted over the telephone, in which the doctor interviewed the remote patient and asked specific questions to determine the cause of the problem, foregoing the physical exam and then issuing a diagnosis over the phone.
The first recorded instance of telehealth involved the creator of the telephone, Alexander Graham Bell, the inventor of the telephone, who used it to summon assistance for a lab assistant who had suffered an acid burn. The use of radio communication and telephone communication by doctors to communicate remotely with patients in remote areas became common in the 1930s. It wasn’t until NASA began sending astronauts into space for extended missions that doctors developed remote heart and respiratory monitoring devices and information was then transmitted back down to Earth via radio signal.
As far back as 1964, the Nebraska Psychiatric Institute began using two-way television links to communicate with the Norfolk State Hospital, which was 112 miles away, for educational and consultation purposes. By 1989, interactive telehealth was seeing use in specialized settings. Telehealth became more commonplace in routine medical practices in the late 1990s thanks to the widespread use of the Internet. Even though minor complaints were easier to diagnose, the number of illnesses that doctors can diagnose without an examination or lab work is limited.
With the continued advancement of medical technology, the expansion in the number of conditions that are treatable via remote visit also expanded. This was especially true with the advent of mobile technology that allowed for better communication between doctors and patients, ranging from email communication, monitoring of conditions via specialized equipment connected to a smartphone, and video chat visits, among other methods of communication. As a result, doctors could send prescriptions to the pharmacy and patients could request refills via smartphone apps and online communication rather than dealing with the doctor’s office staff directly. People who didn’t want to take the risk of contracting illness by visiting a medical facility used video chat and medical mobile application technology to manage their conditions and communicate with their providers remotely after the COVID-19 pandemic started.
Even though telehealth is on the rise, outdated laws governing patient privacy and practices, which fail to take modern mobile technology advancements, such as security, into account, have kept the practice from taking off to the extent that it could have in the last decade, with over 50% increases in insurance claims for telehealth in 2015 and 2016 alone, demonstrating the demand for increased access to telehealth. For patient privacy, laws are being written to allow the use of applications like FaceTime and Zoom, but most laws require connections to take place through a more secure service, some of which have been developed specifically for telehealth.
Approximately 75% of American healthcare facilities have made efforts to include telehealth in their service offerings in response to growing patient demand for telehealth and mobile connectivity. Especially in the fields of highly specialized medicine like teleneurology, the future of telehealth will undoubtedly include a wider range of conditions that are treatable by the practice as technology advances, so we should now turn our attention to the various ways in which it is already in use.
There are more uses for telehealth today than there were a few years ago. For the most part, telehealth is used to assist patients and doctors in monitoring chronic conditions, completing follow-up visits after an office visit, obtaining second opinions, conducting mental health counseling sessions, and providing medical support to patients in assisted living facilities or who are homebound for some reason. It is also used for managing medication and making urgent care visits for minor conditions such as urinary tract infections, sinus infections, and other minor ailments. Some conditions that have seen treatment recently with these methods include: allergies, asthma chronic bronchitis, conjunctivitis, UTIs, back pain, rashes, and diabetes. 
Also known as “store and forward,” this technique involves transferring patient data for later evaluation, such as at a follow-up appointment. Examples of this include results from imaging and diagnostic tests sent to another provider or lab, as well as laboratory results from an urgent care clinic or elsewhere that are analyzed at a laboratory and then sent to a provider for analysis. In specialized medicine, such as cardiology, dermatology, radiology, and endocrinology, these practices are more common.
Patients and healthcare providers can communicate via technology while not in the same room via teleconferencing, which is what most people imagine when they think of TM. For this type of live interaction, users must use video conferencing, live chat, or other real-time communication methods to exchange information in order to say they are practicing real-time telehealth. For minor complaints or emergencies that don’t necessitate an in-person diagnosis, interactive visits are a good option.
This practice, similar to asynchronous TM, makes use of regular and ongoing practices in technology to monitor such things as heart conditions, blood glucose levels, electrocardiograms, or sleep apnea. The patient uses these monitors at home to collect and store data, which are then transmitted electronically to the healthcare provider for diagnosis. Chronically ill patients, high-risk patients, and those who have recently been discharged from a hospital all benefit from this procedure.
Telehealth vs. Telemedicine
Despite the fact that these terms are frequently used interchangeably, it is important to remember that in the medical community, they refer to two distinct practices. There are numerous technologies, practices, and services that fall under the umbrella term “telehealth” that are used to treat patients. Conversely, TM is the practice of using technology to provide clinical services to a patient remotely, without the need for an in-person encounter. Both have similar meanings, but the first refers to a wide range of remote practices, while the second refers to the specific technologies that make this possible.
Benefits and Detriments
Telehealth, like any other practice, has its advantages and disadvantages, but in general, the advantages outweigh the disadvantages, at least according to those who utilize telehealth. All of these things, as well as the provider’s ability to meet these needs remotely, will play a role in determining whether telehealth practices are right for each patient.
When it comes to the patient, remote medicine can save time and money by cutting out the need to take time off from work to visit a doctor’s office, commute to appointments, and expose the patient to other potentially infected patients. Telehealth has many advantages for healthcare providers, including better time management and the ability to see more patients in a shorter period of time each day, easier follow-up with patients at home, fewer cancellations and missed appointments, increased revenue, and immediate reimbursement. Access to specialists, better and more routine patient care, and improved patient engagement can all benefit patients and healthcare providers alike, especially those living in rural areas.
Telehealth has its drawbacks, as no system is perfect. The technology needed to implement the process is currently expensive, sometimes prohibitively so, especially if it requires specialized features and security protocols. Staff members who will be using the equipment will need additional training in its use. There is also the risk that the use of technology may be too complicated for the patient, especially for elderly patients, on the patient’s side. Medical conferencing technology, on the other hand, is still very much in its infancy. Some conditions can’t be managed remotely, while others can be managed remotely only to a certain extent. Choosing TM over in-person consultations may lead to less in-person time with a doctor, or it may result in the mismanagement of a condition due to the limitations of the technology.
People with a urinary tract infection (UTI) must have a urine sample tested for bacteria in order to receive an accurate diagnosis. When providers treat a UTI, it usually only requires a round of antibiotics, so a telehealth visit with a provider who determines that the patient’s complaints point to a UTI may prescribe antibiotics without the actual test. An overuse of antibiotics or a misdiagnosis may occur if the symptoms, which can also be found in other conditions, cause the provider to prescribe medication when it is not necessary. In addition to HIPAA regulations, legislation protecting patient privacy, and specific laws governing what conditions can and cannot be managed via telehealth result in telehealth falling into a large legal crack. As most laws are several years behind current technology, the medical industry has operated largely under what laws it could, even though the fit between laws and technology may not be perfect just yet.
Future of Telehealth
With the COVID-19 pandemic bringing to light the various needs of patients and the ways in which remote medical practices can address those needs, we can see what the future of telehealth holds. To avoid risking exposure to the virus, patients who needed ongoing care turned to telehealth as an alternative method of monitoring chronic conditions and addressing urgent, but minor, issues that would otherwise have gone ignored. In addition to modernizing the healthcare system, telehealth gives patients and healthcare providers more freedom and flexibility, and it makes healthcare more accessible to those who may have difficulty getting to an in-person visit. However, what does this portend for the ensuing years?
It is expected that advances in technology readily available to patients, such as smartphones and smartwatches with monitoring capabilities, will improve telehealth in the coming years. Already, the Apple Watch’s most recent incarnation can monitor heart rate, oxygen levels, detect irregular heartbeats and sleeping patterns, alert first responders after a fall, and provide a single-lead EKG reading that can be exported to a PDF document and uploaded to a cardiologist for review. Future incarnations of the device, or similar devices, might measure blood pressure, blood glucose levels, respiration, and other critical vital readings all from a device a patient wears every day. Wearable technology is on the rise, and integrating with various health applications on smartphones can allow for regular monitoring and uploading of data to medical professionals. Telehealth is here to stay, and as it begins to expand to cover a wider scope of conditions and actions for patients and providers, in the near future, an office visit might be as simple as putting on a virtual reality headset, activating a wearable device, and having a conversation with your provider in a VR environment while all necessary tests and diagnoses are conducted remotely. In this future era, “TM” healthcare will likely be just regular healthcare.