Telemedicine uses telecommunication systems to deliver health care at a distance. This method of delivering health care may improve patient health outcomes, access to health care and reduce costs. It is important to understand the impact that care at a distance via telemedicine might have on patients, healthcare professionals and the organisation of care.

We assessed the effectiveness, acceptability, and costs of interactive telemedicine, delivered in addition to, or as an alternative to, usual care as compared to usual care alone.

Researchers in The Cochrane Collaboration searched the literature up to June 2013 and found 93 eligible randomised controlled trials (N = 22,047 participants). The studies recruited participants with a number of clinical conditions: cardiovascular disease (36 studies), diabetes (21 studies), respiratory conditions (nine studies), mental health problems or substance abuse (seven studies), conditions requiring a specialist consultation (six studies), complex co morbidities (three studies), urogenital conditions (three studies), neurological injuries and conditions (two studies), gastrointestinal conditions (two studies), neonatal conditions requiring specialist care (two studies), patients recovering after solid organ transplantation (one study) and cancer (one study).

Telemedicine provided remote monitoring (55 studies), or real‐time video‐conferencing (38 studies), which was used either alone or in combination. The main telemedicine function varied depending on clinical condition, but fell typically into one of the following six categories, with some overlap: 
i) monitoring of a chronic condition to detect early signs of deterioration and prompt treatment and advice; 
ii) provision of treatment or rehabilitation, for example stroke rehabilitation; 
iii) education and advice for self‐management; 
iv) specialist consultations; 
v) real‐time assessment of clinical status, for example post‐operative assessment after minor operation 
vi); screening for depression or angina.

We found no difference in mortality between participants with heart failure receiving care through telemedicine, compared to those receiving health care without telemedicine. The results of the studies differed for admissions to hospital, from a relative decrease of 64% to an increase of 60%. Disease‐specific quality of life was slightly improved for heart failure participants receiving telemedicine as compared to those receiving usual care only.

We found that telemedicine may improve glucose control in people with diabetes (mean difference (MD) 0.30 percentage points), but that the effect varied across studies: from a MD of ‐0.72 to 0.20 percentage points at a median nine months follow‐up. We found some evidence for a decrease in LDL cholesterol, which is considered the 'bad' cholesterol, in participants allocated to telemedicine as compared to those allocated to usual care (MD ‐12.45 mg/dL). We also found a greater decrease in blood pressure in those allocated to telemedicine compared to those that were allocated to usual care.

Seven studies that recruited participants with different mental health and substance abuse problems reported no differences in the effect of therapy delivered over video‐conferencing, as compared to face‐to‐face delivery. Findings from the other studies varied; there was some evidence that monitoring via telemedicine improved blood pressure control in participants with hypertension, and a few studies reported improvement for those with a respiratory condition. Studies recruiting participants requiring specialist consultation for a dermatological condition reported no differences between groups.

Authors' conclusions

Telemedicine (TM) has the potential to be an effective tool for delivering more frequent and timely health care to people with chronic conditions at a distance, and for improving access to health care.

Source: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002098.pub2/full?highlightAbstract=telemedicine%7Ctelemedicin

It all started in the early 2000s when internet and internet use started to grow exponentially. In 2007, the iPhone emerged. After that, the ability of the global population to access products and services via the internet through mobile networks fundamentally changed our society, our culture, and the market for healthcare services.

Since the early 2000s, the use of the internet and the advent of smartphones have ushered in a new world that has been rapidly evolving over the past 15 years.

Early Telemedicine

Telemedicine began with the concept that a physician could deliver consultations with a patient via audio-only telephone or audio-visual communications tools over the internet. Naturally, the primary benefit of this is improved access to and experience of care. In rural areas, telemedicine allows specialists and primary care teams to provide access to patients who lack geographic proximity to a brick-and-mortar clinic.

The primary criticisms of telemedicine are based on the scope of practice. There truly are certain diagnoses, procedures, and patients that benefit from in-person services. Conversely, there are some conditions and patients where telemedicine is inappropriate or even dangerous. Advocates of telemedicine, or the broader term telehealth, are often too enthusiastic about the ability of telemedicine to “take over the world.” Teladoc and Amwell, in their original business models, took care of mostly sinus infections, rashes, and other low severity, acute needs that have a simple diagnosis and mostly require a straightforward prescription. Simply put, patients cannot receive a lumbar puncture via telemedicine, and conditions like diabetes require long-term care and monitoring from the same physician.

Covid-19 Impact on Telehealth-First Businesses

Traditional telemedicine companies like Teladoc have made moves in the past two years to shift business from low-severity, acute needs to chronic care. Teladoc’s acquisition of Livongo (i.e., Livongo has a virtual program for hypertension and diabetes) is a clear illustration of this strategy. During early Covid-19, practices shut down and patients with diabetes, heart disease, hypertension, cancers, and other conditions were forced to either receive no care or access care via telemedicine technologies. Teladoc was wagering on this trend both accelerating and maintaining in the decade ahead—you can tell they thought this based on their massive Livongo valuation that far outpaced Livongo’s revenue. Covid-19, to many, was a boom and bust event for telemedicine, telehealth, and virtual care businesses. But was it?

There was a boom-bust-bubble-like feel to Covid-19’s impact on telemedicine companies, but it has set the stage for significant growth over the next decade.

A few key thoughts:

But, the most important impact of Covid-19 on our telemedicine-first providers is a new competition.

The pandemic forced every brick-and-mortar health system and single provider practice to implement their telehealth plans early. Physicians were forced to take visits virtually despite years of resistance. At this point, nearly every patient’s physician was offering some form of virtual appointment.

Telemedicine meets Remote-Patient Monitoring (RPM)

When Teladoc acquired Livongo, it was like that whole Mayan Calendar 2012 prophecy (remember that?). The RPM crowd has been talking about the use of IoT devices to monitor patients in the home for both acute and chronic conditions for about a decade and a half. Naturally, they saw a future where telemedicine companies could shift their care models to chronic care via the use of connected devices. But, it was not until 2018-2019 that Medicare began paying for remote-physiological monitoring services—thus creating a billion-dollar market overnight.

With this in mind, Teladoc finally fulfilled the prophecy, but, like the doomsday that never came in 2012, it was not as rapid and revolutionary as foreseen. The issue, for Teladoc/Livongo, still resides in the impact that the brick-and-mortar clinics had on the market. Long-term clinical relationships matter for patient populations with the highest rates of chronic conditions, and specifically, the highest prevalence of hypertension and diabetes. Patients on Medicare and age 50+ have often been with the same practice for years and switching to a newfangled virtual primary care clinic was not in the cards when it is possible to receive the same services from your trusty Primary Care Associates, P.C.

During early Covid-19 and after record RPM investment, brick-and-mortar clinics were inundated by remote-patient monitoring technology companies looking to help them adopt the IoT approach to chronic care and take advantage of Medicare’s reimbursement. So, not only did Primary Care Associates, P.C. adopt an audio-visual telemedicine technology early in the pandemic, but they also started signing up for RPM platforms—just like Teladoc/Livongo.

It is important to note that RPM-based chronic care models are effective for a number of conditions when operated correctly and meaningfully (see this report from AHRQ. I am a firm believer that these care models will become the standard of care in 5 years or less as the evidence continues to mount (but, there are a lot of bad programs).

In the early stages of telemedicine, it was about improved access. Now, telemedicine has expanded to the concept of virtual care that can be more about enhanced care models that cannot be delivered via traditional episodic care approaches. Virta Health has successfully proved that its virtual care model can reverse type 2 diabetes. We have entered a new world that is no longer about telemedicine adoption and volume-driven care, but the development of new, intensive, technology-driven, longitudinal care models. As someone who operates an RPM program for diabetes, hypertension, and congestive heart failure, I see the positive impact the data and the program have on patients, providers, and the nurses operating the RPM program. Anecdotally, these things are great.

So, what will the future look like?

These are a few of the current trends in the market to expect in the coming decade. The acceleration of internet technology and smartphones has opened a new world in which we can reimagine the delivery of healthcare. Improved access, more personalized care, better experiences, and enhanced outcomes can be expected from many of these models. However, there will be cases in which the size of the market leads to bad behavior—see Cerebral. Congress has indicated a willingness to reduce some of the barriers to these care models and a wide, bi-partisan acceptance of telehealth.

Despite all the advances, it is important to remember that too much healthcare can often be as detrimental as not enough. It is all about delivering the right care, to the right patient, at the right time, but more importantly, the best healthcare is prevention—improving diet, exercise, and other lifestyle factors.

Source: https://longyearhealth.substack.com/p/the-evolution-of-telemedicine

While there are many benefits to telemedicine, they don't all come without valid concerns. The great news is that you can overcome these concerns by having a plan. Here are seven telemedicine concerns to take into account and effective strategies for overcoming them.

1. Reimbursement

Getting reimbursed for telemedicine services can prove problematic for physicians and other healthcare providers. Medicare, for example, offers telemedicine reimbursement coverage, but with limitations. 

Reimbursement is possible for services covered under the Medicare Chronic Management Program, such as services for patients who have at least two or more chronic health conditions. These conditions must persist at least one or more years or until death to be considered for reimbursement claims. 

However, the Centers for Medicare and Medicaid Services (CMS) is proposing coverage for 2019 and beyond, including prolonged preventative services and virtual check-ins. Moreover, telemedicine services are not always covered by private insurance companies. 

To overcome reimbursement obstacles, it helps to have a reimbursement plan that includes using technology to track expenses for reimbursement claims. You can employ a platform that keeps track of these expenses so you can properly document receipts required by payers, while keeping up to date on insurers’ allowable reimbursements.

2. Lack of Integration

If your Electronic Health Records (EHR) system doesn't coordinate with the platform you're using to provide telemedicine services, you likely will complicate your workflow records. 

By using a platform that integrates with your EHR, you can record your established workflow and ensure your patients’ e-visits are properly documented and updated for future visits.

3. Lack of Sufficient Data for Care Continuity

A lack of platform integration can also interrupt continuity of care. If a patient receives telemedicine from one service provider, but chooses another provider for his next e-visit, then the second physician may not have all the information she needs to diagnose the patient’s problem. The best solution is to inquire where your patient previously received telemedicine services, including those created at hospitals and providers with other medical facilities. 

4. Service Awareness

If your patients aren't aware of your telemedicine services, then the service won't get used. With approximately 96 percent of large employers planning to offer telemedicine services to their employees, it's a missed opportunity if your patients aren't aware that you're offering these services. 

That's why it's important to plan your launch via content marketing and social media marketing to get the word out. Email newsletters, social media, via email newsletters, social media platforms and your blog, if your practice includes one.

5. Patients’ Lack of Technical Skills

When patients don't understand how to use telemedicine services, it can reduce utilization and hamper accessibility. It’s a good idea to survey patients before launching your telemedicine services, and asking which devices they would be most comfortable using when accessing your telemedicine services. 

It’s equally important to train your staff on using your telemedicine equipment, so they also can help patients who require assistance.

6. Expensive Technology

When you add up the cost of equipment and the cost of services to provide care, telemedicine expenses can be a concern to physicians, hospitals and medical practices. You may be able to reduce expenses by opting for bundled services or those that offer a flat fee, while keeping in mind that as the use of telemedicine continues to grow, technology expenses and service costs will continue to go down. 

Telemedicine services also are helping patients cut down on their costs for in-person visits and ER visits, the latter potentially saving  25 percent on the cost of ER staff.

Telemedicine services can be convenient, but they can also provide a gateway to security and privacy issues, while accessing patient data over the Internet.

HIPAA’s privacy and security rules require that the information gathered through a telemedicine service is encrypted, and you’re network connections. Additionally, when contacting patients, you have to be sure you are messaging them across a secure connection. Before you record and store video calls, you need to get the permission of your patients.


Source: https://telemedicine.arizona.edu/blog/7-telemedicine-concerns-and-how-overcome-them

A teleconference is a live audio or audiovisual meeting with two or more participants. With the ability to teleconference, remote teams in an organization can collaborate and communicate, even when geographically dispersed. The process involves technology more sophisticated than a simple two-way phone connection.

At its simplest, a teleconference can be an interactive audio conference with people at two or more locations communicating over a speakerphone. With more equipment and special arrangements, a teleconference also can be a video conference, in which the participants can see each other.

Telecommunication systems support teleconferences by providing audio, video and data services. Participants communicate with teleconference platforms using devices such as desktop computers, tablets, smartphones and laptops. Teleconferences were initially conducted through telephone lines and were limited to audio; however, now it is more common for teleconferences to be conducted online or using voice over IP (VoIP).

Teleconferencing works differently depending on the type of teleconference used:

Potential advantages of teleconferencing include the following:

There are some downsides that come with teleconferencing, however. Two important factors include the following:

In 1956, Bell Labs became the first organization to develop the concept of telephone conferencing. And in 1964, AT&T exhibited the Picturephone at the New York World's Fair. Users could speak to and see others using a black-and-white screen that managed video and audio using three phone lines. But it took until the 1990s for AT&T to release a more commercially viable version. In 1973, David Brown developed the first chat software for the Plato Notes computer conferencing system.

In 1989, a developer named Brian C. Wiles created RASCAL, which is short for Remote Audio Sound Card Application Link. RASCAL was the first application to send voice over Ethernet networks, or VoIP. In 1991, WebEx Systems developed a higher quality sound and video system capable of being carried over broadband. One year later, AT&T released a commercially viable teleconferencing system.

It took until the 2000s for video teleconferencing to become more widely used. Web conferencing products started being used more frequently for business meetings as well. In 2004, Citrix released GoToMeeting as its first web conferencing product. In 2012, Zoom was released, and Microsoft Teams followed in 2017. During the COVID-19 pandemic, video teleconferencing apps such as these saw a large rise in users, as webinars and group meetings became more normalized -- enabling more workers to do their jobs remotely.

Organizations saw an increase in the use of teleconferencing applications in 2020 and 2021, as employees began working from home more due to the COVID-19 pandemic. Teleconferencing apps enabled teams to stay in touch with each other and remain productive. With a workplace structure steadily leaning toward and becoming more accepting of remote work, it is likely that teleconferencing tools will continue to be used for the foreseeable future.

Some examples of recent and potential advancements in teleconferencing include the following:

Source: 
https://www.techtarget.com/searchunifiedcommunications/definition/teleconference

Teams in an organization have the option to conduct teleconferencing through multiple means, including the following:

Potential advantages of teleconferencing include the following:

There are some downsides that come with teleconferencing, however. Two important factors include the following:

To run an effective teleconference, the host should first understand how the system they are using works. This includes familiarizing themselves with features that may aid their conference, such as messaging and chat or breakout rooms.This image shows the features offered in many teleconference systems.

Before hosting, the user should ensure they have a sufficient amount of bandwidth for the meeting. Documents, agendas and access numbers should be shared ahead of the meeting so that attendees know what the meeting is about, can securely access the meeting and be prepared when it starts. An access number could be a dial-in number or a PIN. Security codes ensure no one joins the meeting who is not supposed to be there. The host should also be mindful of their connection, potential noise distractions or other factors that can impede call quality, such as a lack of good lighting on a video call.

When the meeting occurs, the host may also have the option to record it. They can do this so that attendees can go back and review specific portions of the meeting, or to accommodate those who could not attend.

Some security best practices to follow while having a video conference include enforcing meeting starting times, locking the meeting when all participants are in it and using virtual backgrounds if an attendee's real background is distracting.

Source: https://www.techtarget.com/searchunifiedcommunications/definition/teleconference