Telemedicine, telecare, and telehealth

Telemedicine, telehealth, and telecare are very similar terms, but they aren’t identical in meaning. Each term is used to describe a slightly different way of delivering healthcare.

Telehealth: Telehealth is an umbrella term that refers to the remote delivery of health care services (including monitoring vital signs, remote diagnosis and evaluation, and e-prescriptions), health information services, and health care education. Telehealth, as a broad term, includes the delivery of telecare and telemedicine.

Telecare: Telecare refers to the electronic devices and technologies used to deliver remote healthcare services.

Telemedicine: The World Health Organization (WHO) defines telemedicine as “healing from a distance.” More broadly, telemedicine facilitates the remote delivery of healthcare services that encompass:

• Interactive medicine, allowing patients and physicians to communicate virtually in real-time
• The electronic exchange of medical information, such as X-rays or test results, that medical providers can share with other healthcare professionals
• Remote patient monitoring, which allows healthcare providers to monitor patients’ vital signs (such as heart rate, blood pressure, oxygen saturation, and blood sugar levels) with mobile medical equipment

Providers can offer a range of medical services via telemedicine that can diagnose, treat, and prevent disease and injuries. According to the WHO, there are four key elements crucial to telemedicine:

1. Its purpose is to provide clinical support.
2. It is intended to overcome geographical barriers, connecting users who are not in the same physical location.
3. It involves the use of various types of information and communication technologies, such as computers, the internet, cell phones, and other mobile electronic devices.
4. Its goal is to improve health outcomes.

In essence, telehealth overcomes a number of barriers, such as access and cost, and takes advantage of advanced technology to advance the health of individuals and communities.

The evolution of telehealth

The origins of telehealth can be traced to the early 1900s in Europe, when a Dutch physician, Willem Einthoven, transferred electrocardiograms over long distances using the telegraph in 1905. Telegraphs were also used to order medical supplies and consultations. Historians say that radio consultations followed from medical centers in Norway, Italy, and France in the 1920s-1940s for patients who were aboard ships at sea or on remote islands.

In 1948, the first radiologic images were sent via telephone to two medical centers in Pennsylvania.

By the 1950s, the United States had begun electronic transmission of radiograph images. Canada soon followed suit. In 1959, doctors at the University of Nebraska transferred neurological examinations across campus using a two-way interactive television. By 1960, the Nebraska Psychiatric Unit and Norfolk State Hospital were connected for consultations by closed-circuit television.

In the 1960s, telemedicine expanded on a larger scale throughout the US and Canada, driven by military and space technology industries as well as industries using commercial equipment. By the mid-1960s, formal telemedicine programs were offered in America, via both closed-circuit television and video communication.

The more recent milestones in telemedicine over the last 50 years were advanced as communication moved from analog to digital, and the associated technologies became more affordable. The introduction of the internet-enabled video conferencing, email, and digital transfer of information, as well as the rise of mobile telephones and satellite communication.

Today, the scope of telemedicine has advanced considerably. Web-based applications and multimedia approaches are more readily available. These include digital conferences, teleconsultations, digital video conferencing, and mobile monitoring devices.

Telemedicine 101

• Telehealth: An umbrella term used to describe telecare and telemedicine
• Telemedicine: The delivery of healthcare and exchange of health information remotely and in real-time
• Types of telemedicine: Patient and physician interaction, the transfer of healthcare information, remote patient monitoring, and healthcare education
• Telemedicine devices: Telephone, computers, video technology, electronic devices, mobile phones, and mobile healthcare monitoring devices
• History of telemedicine: Telemedicine has advanced considerably from telegraphs in the early 1900s to video conferencing today
• What telemedicine is not: Telemedicine is not a technology or separate branch of medicine and does not require any extraordinary technical know-how

How does telemedicine work?

Telemedicine is useful for a range of non-urgent health care services and follow-ups, comparable to a visit to your primary care physician. It isn’t appropriate, however, for emergency situations such as broken bones requiring X-rays, heart attacks, major physical traumas, or surgery.

Telemedicine allows health care providers to assess, diagnose, and treat patients without the need for an in-person visit. During a telemedicine appointment, you might want to discuss with your provider: birth control, psychological and mental health issues, potential infections and viruses, prescription refills, or even ways to communicate with your doctor while you’re away from home.

Telemedicine allows the patient to use technology to communicate with their health care provider who is in a different location.

Technologies used include phone calls, apps, video conferencing, email, and text messaging.

All you need for telemedicine to work is a reliable internet connection and a phone, smartphone, computer, or tablet.

There are two common ways to access telemedicine services:

1. Virtual interactions: A provider will ask the patient to download or access a piece of remote healthcare software—this could simply be a link to a secure web browser—that allows the patient to identify themselves and then connects them with their health care provider. The patient can then share health information, such as symptoms and their medical history, and the clinician will assess the person and then make treatment recommendations including prescribing a medication, making a referral to another specialist or provider, or scheduling a follow-up appointment.
2. Patient portals: Providers can offer a patient portal service accessed via a web browser or app. This service allows patients to schedule appointments, request repeat prescriptions, email their provider, and view imaging and lab results.

Other types of telemedicine

Telemedicine allows for remote patient monitoring as well as sharing patient information, a process known as “store and forward.”

Remote monitoring uses mobile devices to monitor and collect data about a patient’s vital signs. These might include blood sugar levels, blood pressure, temperature, heart rate, and oxygen saturation.

Store and forward allows health care providers to securely share patient information, including test results, patient histories, and X-rays.

Telemedicine is also used for specialist services for certain conditions, such as treating substance use disorders and providing psychological services, including psychotherapy.

Who can benefit from telehealth?

Anyone who can access a phone or internet connection can benefit from the convenience of telehealth. It is especially beneficial to those in remote locations, those who have time constraints or can’t leave work, or those who are home-bound. Patients with substance use disorder may feel less stigma accessing services from the privacy of their own home than when visiting an addiction treatment center.

Why telemedicine is important

Telemedicine is important because it improves access to quality healthcare and allows patients to take care of their health care problems without having to wait for an in-person appointment. It allows patients to communicate with their doctors in real-time rather than try to cover all their concerns during an often-rushed appointment.

Basic principles and guidelines of telemedicine

In 2009, the World Medical Association set out guiding principles for the use of telemedicine. These include:

• Duty of care: The provider must give clear direction as to who has ongoing responsibility for the patient’s care and follow-ups.
• Communication with patients: Providers are responsible for ensuring quality communication during the telemedicine encounter.
• Standards of practice/quality of clinical care: The provider must be satisfied with the standard of care provided during a telehealth appointment is reasonable. If it fails to meet that standard, then the provider should invite the patient for an in-person appointment.
• Clinical outcomes: Physicians should strive to provide the best possible outcomes and quality of care
• Patient confidentiality: Patient information should be protected and kept confidentially in accordance with relevant legislation and governing bodies.
• Informed consent: Relevant legislation and regulations relating to patient decision-making and consent should be applied before health care services, if possible.

How to get the most out of telemedicine

The most effective way to use telemedicine is to be prepared. Here is a short checklist to make sure you get the most out of your telemedicine service:

• Call your insurer and check if telemedicine is covered before booking an appointment.
• Check mobile/computer devices ahead of time to ensure they work and check the bandwidth of your Wi-fi signal for video. Try video calling a friend to ensure the picture is clear and there isn’t a delay in communicating. If there is, consider calling your internet provider and upgrading your bandwidth.
• Download the software or access the web browser at least a day before your appointment so you have time to call and receive technical support if something isn’t working properly.
• Visit the patient portal and learn how it works before your appointment. If possible, schedule a trial run. Find out how you can reach the doctor’s office in case you experience technical difficulties on the day of the appointment.
• Make a list of symptoms, questions, and anything else you want to discuss before the appointment.