Telemedicine: Part II

October 21, 2016

Telemedicine has been described as one of the greatest disruptive forces in health care history, destined to change the fundamental interaction between patients and providers.  Yet there is a surprising lack of understanding, or agreement, as to what is telemedicine.  To understand the various telemedicine models, we first look at the very basic telemedicine concepts, beginning with the question of what is telemedicine?

One could certainly be forgiven for lacking a clear idea of how to answer this inquiry. At least five different federal agencies have adopted their own definitions of the word. The World Health Organization released a report in 2010 that noted the existence of over 100 distinct, different peer reviewed definitions of the term; it is a safe bet that number has not shrunk in the ensuing years. The endeavor is further complicated by a general industry acceptance of other related terms including the similarly sounding “telehealth” (with at least six different federal agency definitions), “e-Health” and “m-Health.” Despite this overabundance of perspectives, there are some generally accepted parameters for each of these terms.

“Telehealth” is usually considered the broadest term. It encompasses both clinical and non-clinical provision of health information through an interactive platform. “Telemedicine” is usually focused on only the clinical aspect of care. For instance, a provider giving advice to a diabetic patient regarding glucose levels over an audio-visual link would be telemedicine; an app that merely collects glucose level data and refers the patient to generalized diet and meal planning advice for diabetics would be included in telehealth.

Telemedicine is also generally divided into two categories: synchronous and asynchronous store-and-forward technologies. Synchronous allows real-time interaction between a patient and provider. Asynchronous store-and-forward allows data to be collected from a patient, stored often in a medical record, and forwarded to the provider for analysis without the patient’s further involvement. Again, our “office visit” in which a diabetic patient and physician communicate about glucose levels through audio-visual technology is synchronous telemedicine.  A patient who has an x-ray that is digitally transmitted to a radiologist to be read at the radiologist’s convenience, is using asynchronous store-and-forward technology.

Concepts of e-Health and m-Health, or electronic health and mobile health, are even more poorly-defined hybrid categories invoking concepts from all of the above. These terms are typically applied to technologies that can span the gamut from popular wearable workout devices used for patients’ own education and monitoring to experimental smart rooms that can track virtually every movement a patient makes, process the huge amounts of data collected and forward that data to researchers for real-time monitoring.

Because many see telemedicine as the key to providing greater access to health care at more efficient cost, numerous different delivery models have been created. Private dedicated telemedicine companies have developed web, phone and mobile app platforms providing 24/7 – 365 access to a physician for basic consultative services. These often include not only purely medical consultation but behavioral health and even drug and alcohol counseling services.  Well-established tertiary care centers have partnered with smaller, often rural providers to provide access to specialized services. This can be done through networked systems or direct point-to-point connections. Dedicated monitoring centers collect, record and respond to patients’ data in partnership with primary providers to allow immediate response to concerning developments or track health conditions over time in a manner not previously possible. Entrepreneurs are experimenting with “hospitals” that forego traditional brick-and-mortar facilities in favor of a home setting for care coupled with telemedicine technologies.

These models are springing up in response to clear consumer demand. Gone are the days of general acceptance of health care delivered on the terms of health care providers. Patients are demanding greater access and providers, understandably, are seeking ways to provide that service. But patients, in their desire for access, are often inclined to overlook the necessary privacy security features that need to exist around healthcare information. They will want treatments that may be unwise to provide without physical examination. This consumer-driven nature of the revolution adds yet another dynamic in which consumer expectations can create significant tensions with existing regulations designed to protect the quality and integrity of health care.

Each of these various models carries with it challenges that are specific to that model. At their core, though, each of the challenges derives from certain basic concerns in the delivery of health care. It is generally accepted that successful telemedicine operations will adhere to a few basic tenets. First, the model must not run afoul of existing regulatory frameworks. Second, the quality of care must be sound. Third, the privacy of patient information must be protected. Fourth, the model must be economically viable in that it sufficiently rewards practitioners for delivering the promised efficiencies of telemedicine to consumers.  Fifth, the model must be attractive to the consumers of medical care.  Not surprisingly, the pressures created by these various concerns will, at times, work in conflict with one another.

In the next section, we turn to the key regulatory structures in place that impact telemedicine delivery models. If you have questions concerning these specific telemedicine models or emerging models, please contact us.

For more information about "Telemedicine: Part II," contact Guy J. DuBeau at or 608.283.6704.