A Report on the Limitations Faced by Virtual Consultations in the US

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The intersection of technology and medicine can be confusing for some. Policymakers, advocacy groups, and vendors often throw out technical terms or use imprecise language inconsistently. And two common terms that have been used interchangeably a lot, especially in the last year. Even though they are similar in some regards, there are a few noteworthy differences between the two. Clinicians must know these differences so that they are able to engage in discussions and plan the role telehealth and medicine might play in improving the delivery of care. Read on to learn about the difference between telehealth and telemedicine in the US.

Telemedicine

Telemedicine, a subset of telehealth, refers to the provision of education and healthcare services over a distance conducted by using telecommunications technology. According to the Federal Communications Commission (FCC), telemedicine involves using telecommunications technologies for supporting the delivery of all types of diagnostic and treatment services. The American Academy of Family Physicians (AAFP) has defined telemedicine as practicing medicine using technology for delivering care at a distance.

In simple terms, it involves using software and electronic communications for providing clinical services to the patients so that they don’t have to come in for an in-person visit. Many hospitals use telemedicine technology frequently for follow-up visits, medication management, managing chronic conditions, specialist consultation, and other medical services that are offered remotely using secure audio and video connections. Some define telemedicine as a process integrating information technology or communication with the practice of medicine for delivering remote care. To do this, the hospital will need electronic communications as well as relevant technological components. This way, patients will have a way to access clinical services remotely. Also, it will help clinicians monitor the patient remotely that withdraws the need for an in-person visit.

Because of the global pandemic, there has been a significant increase in Telemedicine technology adoption. With telemedicine, people were able to access follow-up visits, specialist consultation, medication management, and management of chronic conditions. The global health care system of the contemporary world that we are living in today is continuously changing; all thanks to technological innovation. Thanks to telemedicine technology, now it’s possible for people living in rural and remote areas to get high-quality healthcare service. Even though there are some challenges to implementing this model of healthcare, the benefits it offers far outweigh them. Telemedicine offers far-reaching benefits through its approaches for supporting primary care clinicians, reducing costs, and centralizing specialists.

By encouraging the adoption of telemedicine all over the world, human civilization will be better equipped for adapting to public health emergencies like COVID-19. Such situations require the deployment of a large number of healthcare providers that can offer basic healthcare services; something which local healthcare centers are not capable of delivering.

Telemedicine can be a means of offering information to infected as well as non-infected people. That is why it is crucial to see telemedicine not just for public health emergencies, but also for managing chronic conditions such as heart conditions, diabetes, or others. Implementing this will require discussion and integration of telemedicine in the healthcare system, redesigning clinical care models, and getting funding. It is safe to assume that as communications technology continues to progress and advance, the healthcare service delivery quality will improve because of the correlation between both domains. The increased demand for innovations and the progress made in information technology has already led to the emergence of several new methods like automated logic flows that are capable of identifying high- and moderate-risk patients and directing them to triage lines.

Telehealth

Telehealth refers to the broad range of services and technologies used for providing patient care and improving the whole healthcare delivery system. According to the Federal Communications Commission (FCC), telehealth is similar to telemedicine, but it includes a wider range of remote health care services other than the doctor-patient relationship. The AAFP refined telehealth as the telecommunications and electronic technologies and services that can be used for providing care at a distance.

The main difference between telehealth and telemedicine is that the former refers to a wider scope of remote services than telemedicine. Telemedicine refers to remote clinical services specifically whereas telehealth can refer to remote clinical services as well as non-clinical services like administrative meetings, continuing medical education, and provider training.

Telehealth can be considered as a subset of E-Health that includes delivering health information for health consumers, health professionals, training and education of health workers, and health systems management using telecommunications and the internet.

The CCHP (Center for Connected Health Policy) identifies four telehealth modalities – live video, mobile health, store-and-forward, and remote patient monitoring.

1. Live video – This is a two-way, real-time interaction supporting health care services. All the participants in the video conference can talk to each other, which is why this is a synchronous mode of communication. An example of this is a dermatologist examining a mole over a live video call. Another example is a medical consultation. It can also be used for a remote training session that is broadcasted from a medical center.

2. Store and Forward – This includes the transmission of digital images, text, or video that is recorded, stored, and forwarded. It is considered to be an asynchronous mode of communication since there isn’t any real-time interaction among the participants. An example of this is a patient taking a photo of their tooth injury and sending it to a dentist.

3. Remote Patient Monitoring – This covers the transmission of medical data like glucose readings, blood oxygen, and blood pressure. RPM technologies involve patients taking the readings and sending the data as needed or on a schedule. Here are some conventional measurements devices that can be used for RPM:

? Wearable biosensors like heart rate monitors and wristbands

? Vital sign monitoring devices

? Smartphone cameras

? Otoscopes (ear exams)

? Ophthalmoscopes (eye exams)

? Digital stethoscopes

4. Mobile Health – This includes using mobile devices like smartphones and tablets for transmitting health information. For example, preoperative instructions that are texted to the patient so that they can prepare for their surgery.

So, compared to telemedicine, telehealth covers more ground. It can include remote monitoring of your vital signs, a scheduled text message that reminds you to get a vaccine, ongoing training for medical professionals, a remote physiotherapy session, a neurology consultation, and patients reviewing their lab results by logging into their portal. Telehealth covers most disciplines including physical therapy, psychiatry, social work, dentistry, cardiology, home health, and social work. It’s all about offering better healthcare services to the patients.

Examples of telemedicine

In order to understand the difference between telehealth and telemedicine, here are a few example activities of telemedicine:

1. According to a 2018 survey conducted by the American Medical Association, the field that is number one on the list of using telemedicine for interacting with patients than other medical specialties is radiology. For instance, a CT scan is securely sent over the internet and the physician receives the generated report. In a telemedicine appointment, the remote physician will be notified that the patient is waiting in line. Then, they will use the electronic records for reviewing the patient’s information, talk to them over video or phone, document their findings, and communicate their recommendations or suggestions to the requesting physician. Apart from the minor differences regarding video availability and specialty, the infrastructure remains the same.
2. An example of telemedicine activity is teledermatology. According to the case study published in NEJM Catalyst, the teledermatology process has three steps. The first step is taking images in the doctor’s office and uploading them into a system. The second step is the remote doctor reviewing the uploaded images and sharing their observations. The final step is the primary care doctors reviewing the reports and determining if appointments are required.
3. Kaiser Permanente, a healthcare company, has physicians including mental health professionals, primary care doctors, emergency doctors, and pediatricians that offer video visits to patients. Patients use these video appointments for follow-up appointments, flu, joint problems, eye problems, wounds and cuts, sore throat, and questions.

Examples of telehealth

Here are a few example telehealth activities:

1. One of the examples of successful adoption of telehealth is telepharmacy. According to the US Pharmacist, telepharmacy leverages technology that allows a pharmacist to review and supervise prescriptions at several locations. Patients can pick up their medicines from a licensed location. They will also be able to take from a pharmacist just like they get at their home pharmacy. The only difference is that instead of in-person, it will be done through a screen.
2. Another telehealth function that is expanding is Telehealth nursing. According to an article published by Nursing 2019, Telehealth nursing can be considered to be a tool that enables the deliverance of remote nursing care in order to improve patient access to health care and efficiency. The service includes guiding patients to the emergency departments, educating them about self-care, assisting with scheduling appointments, and clarifying appropriate treatment options.
3. Telecare, used commonly in Europe, has started to gain traction in the US. According to FCC, telecare refers to the technology that consumers can use to get quality healthcare while staying inside their homes. Even though telecare involves using advanced technologies like sensors, apps, and other tools, many organizations leverage it in a simple fashion like Minnesota’s Winona Health. According to the organizations, their telecare service is a volunteer-based service in which volunteers make phone calls to their telecare clients daily, including holidays and weekends. Through the phone call, individuals living alone are able to remain connected daily and know if they are not able to reach their phone, someone will follow up.

Out of both terms, the older one is telemedicine. The “Telemedicine: A Guide to Assessing Telecommunications in Health Care” book states that as per a review, telemedicine was first referenced in the medical literature in 1950. According to the article, the transmission began in 1948 when radiologic images were sent by telephone to 24 miles from West Chester to Philadelphia, Pennsylvania. Another book named “The Role of Telehealth in an Evolving Health Care Environment” notes an article published in 1879 that talks about using a telephone for reducing unnecessary visits to the office. In the magazine Science and Invention of 1925, there is a cover of a doctor who is using the radio for diagnosing the patient. It also envisions a device through which the doctor will be able to visually examine the patient remotely.

The telehealth term has only emerged in recent years. There are some people who merge this term with telemedicine. But, there are clear differences between the two. Here are a few individuals and organizations that explain the differences between telehealth and telemedicine:

According to HealthIT.gov, the difference between telehealth and telemedicine is that the former refers to a much wider scope of remote healthcare services than the latter. Also, telemedicine refers to remote services specifically whereas telehealth refers to remote clinical as well as non-clinical services including administrative meetings, continuing education, and provider training.

The AARP has blurred the line between these two even more by coining a new term ‘virtual care’. According to them, virtual care covers the diagnosis as well as treatment of patients remotely by experts who are in another city or even country.

So, how should an organization use these terms. According to the Telehealth Alliance of Oregon, an organization should use the definition that is easiest for them to understand and internally implement. However, when an organization has to work with other organizations, specifically in regards to grants, licensure, or reimbursements, it is crucial to clarify the terms used by that organization.

There is another term that is used by the World Health Organization – telematics. As per them, telematics is a composite term for both telehealth and telemedicine, as well as for any health-related activity that is carried out over a long distance using means of communication or information technologies. In short, not all telehealth is telemedicine, but all telemedicine is telehealth. Both of them are a part of the mission of expanding access to care, improving the healthcare delivery network’s efficiency, and making health management easy for patients.