What Is Telemedicine?
“Telemedicine at its simplest level is the practice of medicine using communication technology to deliver care with the patient at one site and the provider at another site,” says Brian Zack, MD, medical director of telehealth for University Hospitals and a pediatrician at UH Rainbow Babies & Children’s in Cleveland, Ohio.
Patients and providers can benefit from using telemedicine for a number of reasons, including access to specialists and the convenience of connecting with a health care professional without going to an office. Especially during COVID-19, the ability to receive care without risking exposure to the virus has allowed patients to keep appointments.
“There are certainly specialists that are more accessible,” Dr. Zack says, noting that less than 5% of UH psychology and psychiatry appointments were virtual before COVID-19. “Now, 93% to 97% are virtual, and there’s no indication that this will change. They are finding sessions to be more productive when people are at home and comfortable.”
How is Telemedicine Defined?
You might be wondering if there is a difference between telemedicine and telehealth, two common terms associated with modern digital medicine. According to the American Academy of Family Practitioners (AAFP) telehealth is the broad category of electronic and telecommunications technologies and services used to provide care when a patient and provider are distant or between distant providers.
Telehealth encompasses:
- Clinical services
- Provider training
- Administrative meetings
- Continuing medical education
- Electronic medical record platforms
- Remote monitoring
Telemedicine has a narrower scope than that of telehealth and refers more specifically to using technology to deliver care at a distance, according to AAFP. “Telemedicine specifically refers to remote medical services,” says Sophia Tolliver, MD, clinical assistant professor of family medicine and a family medical physician at Ohio State University Family Medicine at Outpatient Care East, Columbus, Ohio.
Digital health is also a broad term that includes any way a patient and provider interact, from messaging in a patient portal to accessing lab results online, Dr. Zack adds. “Telehealth falls under that, and telemedicine is the delivery of care, whether a visit that’s audio or video,” he says.
The Benefits of Telemedicine
Quality, access and cost are three main benefits of telemedicine, says Brian Skow, MD, chief medical officer at Avera eCare, a 24/7 virtual hospital that supports more than 500 facilities, hospitals, clinics and nursing homes in 36 states.
Quality: Quality speaks to improving care that patients receive remotely. Dr. Skow points to the American Board of Telehealth, a new organization that strives to educate the next generation of telemedicine providers to ensure proper credentials and training to “ensure patients receive the highest quality of care through their telemedicine visits.”
Access: Access is a huge benefit for patients. “Not only is telemedicine convenient because you can do it from your home, it opens up flexibility to access providers,” Dr. Zack says. It removes barriers like office location, for example.
Also, patients avoid waiting in a doctor’s office, Dr. Tolliver points out. “For patients, when you are getting ready to see your doctor, there are concerns like traffic, parking, wait times,” she says. “You check in and wait. You get your vitals done and wait. You get roomed and wait. If you are going to be waiting, what better place than at home?” A telemedicine visit can reduce a several-hours process to a far more efficient 20 to 30 minute virtual encounter.
Telemedicine can bring specialty care close to home for those living in rural areas where access to certain types of care can require travel, Dr. Skow adds. He explains how Avera eCare’s Sexual Assault Nurse Examiner (SANE) service line was developed because of a demand for these specialists in regions where a victim might have to be transported several hours from the local hospital to receive the examination. “Our virtual SANE program allows a nurser within our hub to assist a bedside provider [through video] with this much-needed examination,” he says, noting that telemedicine will continue to evolve as patient and provider needs are identified.
Cost: “We can lower the cost of care delivery and potentially increase revenue at local hospitals because they can admit patients that normally they could not. Telemedicine gives them resources to provide a higher level for specialty care, Dr. Skow says, relating that Avera eCare expands hospitals’ capabilities.
Cost savings also comes from efficiencies like eliminating drive time to a physician’s office, and for many patients, it will save them the cost of lost wages from taking time off from work.
Is Telemedicine as Good as an Office Visit?
Is telemedicine second to an in-person office visit? Not necessarily. For some types of care, telemedicine can be more effective and efficient, catering to patients’ needs without the hassle of showing up in an office.
“It’s not a binary choice,” Dr. Zack emphasizes. “You are not choosing a live vs. virtual visit. You are choosing the type of visit that is most clinically appropriate for you, and it’s up to the physician or office staff to help you figure out what that is.”
Sometimes, a visit starts virtually and leads to an in-person follow-up. “As a general pediatrician, I have been doing lots of virtual visits where we start the visit virtually, assess the patient, and I either feel comfortable that I can assess, diagnose and treat the symptoms, or I say, ‘I’m going to have to lay hands on. I’ll have to look in your throat or ears and listen to your heart,’” Dr. Zack says.
Some patients are much more comfortable having a telemedicine appointment and are more likely to schedule regular physicals or seek necessary care this way. “There are the patients we see every few years, and then when they come into the clinic, maybe their blood pressure is through the roof,” Dr. Tolliver says. “For those patients who feel barriers to getting into the office, telemedicine is an incentive to continue their care.”
How Is Telemedicine Care Provided to Patients?
Telemedicine is delivered asynchronously and synchronously. Telemedicine can also occur by telephone and include online interactions through a patient/provider portal.
“There is a direct video-to-video encounter, which we call interactive,” Dr. Skow says. “There is store-and-forward, like with dermatology. An original site will store pictures of, let’s say rashes, then forward it on to the dermatologist, who can sit down and ‘see’ a dozen patients in a short period of time and write recommendations.”
Remote patient monitoring is another version of telemedicine. In this case, patients are typically provided with medical devices like blood pressure monitors, weight scales or glucometers that they use in their homes to take readings. These devices communicate the results wirelessly to the patient’s provider who can interpret the data and manage the patient from afar.
Dr. Skow says synchronous video-to-video visits are highly beneficial because “the video connection adds so much.” For example, a phone call describing a wound might not reveal whether it requires sutures or surgical care. “That video encounter adds an extra piece of information that makes a huge difference with patient care.”
However, a live video experience is not always necessary for effective telemedicine. Filling medication requests or answering wellness questions can occur on a virtual platform, Dr. Tolliver says. “Patients can send messages and I can reply back, they can answer questionnaires online to help us gather information about certain diseases or medical history,” she says.
Telemedicine is not a brand-new phenomenon and began in the early 1920s with radio, evolving to the telephone and now involves robust digital technology, Dr. Zack points out. Through the generations, patients have adopted new ways of communicating and providers can leverage those to deliver care.
He says, “In today’s world, it’s really about using any device that improves communication and, therefore, improves delivery of care.”
Ultimately telemedicine is a tool that enables patients to receive the right level of care at the right time, at the most efficient cost.