Telehealth enables healthcare providers to deliver clinical and non-clinical services including medical care, provider and patient education, etc. through the use of two-way, real-time interactive digital telecommunications and other technologies. It is a convenient, accessible, and cost-effective alternative to in-person healthcare services, especially in areas with limited access to healthcare services and enables patients to receive medical care from their homes or other locations outside of traditional healthcare facilities.
Examples of clinical services: virtual consultations, follow-up visits, management of chronic conditions, medication management, remote monitoring of patient health, specialist consultation
Examples of non-clinical services: provider training, administrative meetings, and continuing medical education.
Telehealth vs. Telemedicine: What is the difference?
The American Telemedicine Association (ATA), among many organizations and individuals, considers the words “telehealth” and “telemedicine” synonymous. However, the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services notes a distinction between these two terms.
1. Scope of Services
HRSA considers telehealth to have a broader scope than telemedicine. While “telemedicine refers specifically to remote clinical services”, such as the transmission of radiologic images or a consultation between clinicians, "telehealth includes remote non-clinical services” such as provider training and continuing medical education, as well as “direct, electronic patient-to-provider interactions” through the use of devices “that collect and transmit health information to help monitor or manage chronic conditions”.
2. Technology Requirements
While telehealth and telemedicine both rely on technology to deliver remote healthcare services, the specific technology requirements for each can vary. Telemedicine typically requires more advanced technology, such as high-resolution cameras and real-time video conferencing software, to allow healthcare providers to deliver clinical services at a distance. Telehealth services, on the other hand, may be delivered through more basic technology, such as smartphones, tablets, or simple messaging platforms.
3. Regulatory Requirements
Telemedicine services may be subject to additional regulatory requirements compared to telehealth services. For example, telemedicine services may need to comply with specific regulations related to patient privacy and data security, as well as state and federal licensing requirements for healthcare providers. Telehealth services may have fewer regulatory requirements, especially if they are focused on non-clinical services like patient education or wellness coaching.
In summary, while telemedicine and telehealth are related terms, there are important differences between the two, including the scope of services, technology requirements, and regulatory requirements. Understanding these differences can help patients and healthcare providers choose the most appropriate remote healthcare services for their needs.
Types or Modalities of Providing Telemedicine Services
The Health IT Playbook describes four telehealth modes:
- Live video (synchronous)
Live, 2-way interaction between a person (patient, caregiver, or provider) and a provider using audiovisual telecommunications technology.
- Store-and-forward (SFT)
Transmitting videos and digital images through a secure, electronic communications system. As compared to a “real-time” visit, this service provides access to data after it’s been collected. Generally, Providers record or capture diagnostic information (like X-rays, CT scans, EEG printouts) at the patient’s care site. Then they send them to a specialist in another location using a telecommunication tool such as secure email. Because of the time delay between the image’s transmission and when it’s interpreted, SFT is often referred to as “asynchronous.”
- Remote patient monitoring (RPM)
Personal health and medical data collection from a patient in one location, which is then transmitted to a provider in a different location. RPM helps clinicians and patients manage chronic illness. It uses devices, such as Holter monitors, to transmit information, including vital statistics — like heart rate, blood pressure, and blood oxygen levels.
- Mobile health (mHealth)
Smartphone apps designed to foster health and well-being. These apps offer a wide range of health-related help. A small sample includes apps that send targeted text messages to encourage healthy behaviors, alerts about disease outbreaks, and reminders that help patients adhere to specific care regimens. Increasingly, smartphones may use cameras, microphones, or other sensors and transducers to capture vital signs and venture into RPM.
Telehealth Implementation Challenges
Any new technology, regardless of the industry, faces some initial implementation challenges. Fortunately, as the uses of telemedicine have become more widespread, solutions have arisen to make the transition more seamless. Some common implementation challenges include:
- Reimbursement and billing concerns
- Integration challenges
- Technological challenges
- Security and privacy concerns
1. Reimbursement and billing concerns
One of the biggest concerns that providers have when implementing a telehealth program is getting reimbursed for their services. This concern manifests itself in two ways. First, providers are concerned that they will experience a reduction of income by offering remote services in lieu of traditional in office visits. Second, providers find billing codes confusing and restrictive. As we explain below, however, telehealth programs are highly profitable and partnering with the right telemedicine partner can simplify and streamline the billing process.
2. Integration challenges
One of the most common problems that healthcare providers report is that their telehealth platform fails to integrate with their EHR system. As a result, workflow processes and records are complicated. Providers have difficultly documenting e-visits and maintaining treatment records. This problem extends to the patient level in the form of an interruption of the continuity of care. In other words, if a patient decides to switch to a new provider in the future, the new provider will have difficulty accessing the patient’s treatment records.
3. Technological challenges
No matter the industry, technological innovations typically experience an initial pushback from those resistant to change. The medical industry is no exception. Elderly patients can be resistant to the prospect of receiving medical treatment outside of a traditional office setting or learning how to use new devices. Providers worry that educating patients on programs and devices, as well as troubleshooting tech issues will place further burdens on staff.
4. Security and privacy concerns
Under HIPAA, providers must implement safeguards to prevent the unauthorized disclosure of personal health information. Providers worry that they could be exposed to hefty fines for violations. Moreover, they worry that implementing security measures are cost prohibitive.
Solutions for common telehealth challenges
While telemedicine implementation presents some unique challenges, there are, fortunately, some viable solutions.
1. Integration solutions
Solving integration issues is as simple as choosing the right platform and partnering with the right telehealth partner. Providers should choose a platform that integrates with their EHR. Even better, providers should choose a fully integrated solution – EHR that is already integrated with a telehealth platform.
2. Reimbursement and billing solutions
CMS has greatly expanded billing codes to accommodate the rapid growth of telehealth. Providers should become familiar with these codes. To streamline the billing process and maximize revenue, providers can opt for revenue cycle management solution providers that offer complete medical billing solutions.
3. Overcoming technological challenges
Much of the technical concerns with implementation can be addressed by choosing an out-of-the-box solution. For instance, mobile application-based telehealth programs give patients the convenience and comfort of doing everything on their smartphone. Older patients are more willing to use devices that they are familiar with. And despite public perception that seniors are resistant to new technology, research shows that seniors are more digitally connected than ever. These solutions are also affordable, readily available, and easy to train patients on.
4. Privacy and security issues
HIPAA imposes strict and burdensome obligations on providers for the security of patient data. For instance, data must be encrypted, and communications must occur on a secured network or line of communication. Short of hiring a dedicated legal or HIPAA compliance expert to oversee the daily operations of your telemedicine program, you could choose a technology partner that offers HIPAA compliant systems. These systems are secure and prevent the inadvertent disclosure of confidential patient information.
Telehealth best practices
The success of any telehealth program depends largely on the methods used to implement and operate the program. While every practice is different, there are some best practices that every provider should follow.
#1 – Access your practice and designate staff and/or a team to oversee the implementation process
You know your practice better than anyone. This includes both your strengths and weaknesses. A weakness might be that your staff is overburdened. Or that your patients complain about excessive wait times. Or that your practice has become less profitable due to rising costs. All these factors highlight the need for a telemedicine program.
Yet, you should ensure that you have the correct team in place. An experienced telemedicine provider is invaluable to the success of your program. In addition to laying the technological groundwork, they can provide important guidance and support throughout the process. You should also decide what roles each staff member will play in the process.
#2 – Set goals
Decide what you want to achieve. Whether it is improving the quality of care your practice provides, reducing costs, or boosting revenue, put your goals down on paper. The more specific you can be the better. List what you hope to achieve and when you will achieve it by.
#3 – Educate your team on billing and reimbursement
Telemedicine billing can be confusing since codes are relatively new and guidelines are constantly changing. Educate your team on applicable billing codes. Consider investing in software that includes up-to-date billing and reimbursement information to automate the process for you.
#4 - Market the services to both new and existing patients
An indispensable part of the process is educating your patients. First, you need to make them aware of the new services that you are offering. Explain the benefits of telemedicine, as well as coverages. You may experience some initial resistance from some patients. Show them how easy it is to use the technology to alleviate their concerns. Be sure to advertise your telemedicine services to potential patients to increase your practice size.
#5 - Evaluate
Continually review your goals. Decide what is working and what is not. Ask your patients for feedback. Make changes. Continue to evaluate your program on a regular basis, trying new things along the way until you have found the winning formula.
Standalone vs. EHR Integrated Telehealth?
While telehealth services do not need to be integrated into an EHR, doing so leverages the patient’s clinical information already in the EHR to support and improve continuity of care.
In an integrated system, providers are able to give better quality care when they have access to a more comprehensive picture of the patient’s health and medical conditions beyond a single visit. This may include laboratory and imaging results over a period of time as well as progress from other clinicians, among others.
Key Considerations for Practices Implementing Telehealth
- Research and understand the implications of adding telehealth to your practice. Even when you can’t immediately implement a full-fledged virtual visit program, some aspects of telehealth such as secure messaging and online scheduling via a patient portal may be possible and can help pave the way for more offerings in the future.
- Work out the logistical details with your leadership team and staff.
- Perform due diligence by researching and understanding federal regulations, state laws, and commercial payer reimbursement rules.
- Communicate the plan with your patient base and solicit their feedback. This will give you an idea of the level of interest and demand from your patients.
- Discuss the availability of telemedicine features with your EHR vendor.
- Once providers understand why telemedicine is important to the structure of their practice, they can then work on finding the perfect vendor of telemedicine software to set their practice up for success. A quality vendor is crucial to making sure a practice has the quality technology it needs to provide quality care.
The American Medical Association has an online module called Steps Forward: Adopting Telemdedicine in Practice, which walks Providers and practices through the process of evaluating and preparing to launch a telemedicine/telehealth service.
Additionally, the Telehealth Resource Center has comprehensive information for organizations and individuals who are actively providing or interested in providing health care at a distance.
Specialties Leveraging Telemedicine
According to a recent report, the top 15 physician specialties that are most engaged with telemedicine are:
3. Internal medicine
5. Family medicine
8. Emergency medicine
10. Allergy and immunology
12. Infectious disease
14. Pediatric pulmonology
15. Occupational medicine
Telemedicine Use Cases
Telemedicine use in family practice:
- Wellness exam follow-up appointments that do not require an in-person exam
- Minor urgent care visits such as cold and flu, allergies, UTIs, diarrhea, and vomiting
- Non-urgent care visits to access treatment for “lifestyle” conditions
- Leveraging remote patient monitoring technology to streamline chronic disease management
Telehealth applications in women’s health:
- Menopause and hormone replacement therapy management
- Birth control prescription management and monitoring
- Postpartum depression screenings and video consults
- Remote lactation assistance through video consults
- Reproductive guidance
Applications for Behavioral health:
- Psychiatric evaluation and diagnosis via asynchronous or synchronous consultations
- On-demand mental health counseling via video consultation
- Medication management using mobile health applications or remote patient monitoring programs
Applications for Pediatric Telehealth
- Acute-care video visits at schools or daycares
- Pre-transport assessments for critical care at community hospitals
- Remote patient monitoring of chronic conditions
- Specialty video consults to support primary care in remote areas
- Post-surgery follow-up appointments from the comfort of home
- Remote medication management