Telehealth

Telehealth is a way to give health care and health education from far away using computers and the internet. It helps doctors and patients talk to each other, share health records, and get care even when they are not in the same place. This can be very useful when it is hard for people to travel to see a doctor, like when they live in places far from hospitals or during times when being close together is not safe.

Telehealth includes many different tools and ways to help people stay healthy. For example, doctors can talk to each other using video calls, patients can get advice from doctors online, and people can monitor their own health at home and send the information to doctors. Telehealth can make it easier for everyone to get the care they need, no matter where they live or what the situation is.

Telemedicine is a part of telehealth. It means doctors giving medical care to patients who are far away, using computers or phones to talk and share information. This helps a lot when there are not enough doctors nearby or when travel is difficult. Telehealth and telemedicine together help make health care better and easier to reach for many people.

Telehealth versus telemedicine

Telehealth and telemedicine are often thought of as the same thing, but they are a little different. Telemedicine is mainly about remote clinical services, like diagnosing and checking health problems. Telehealth is broader. It includes clinical care, but also preventative and educational health services, and administrative tasks.

Different groups define these words in slightly different ways. Some say telehealth includes training for health providers and other non-clinical activities, while telemedicine is only about remote clinical care. Others use the two words interchangeably. The term eHealth is also related and is sometimes used to cover telehealth, electronic medical records, and other health technology tools.

Methods and modalities

Further information: List of video telecommunication services and product brands

Telehealth needs good Internet access, usually with a strong and reliable broadband connection or mobile technology like 4G or LTE. As Internet services have improved, more people can use telehealth.

Healthcare providers often start with a needs assessment to see how telehealth can help, like saving travel time or money. Technology companies can help make the switch easier.

Telehealth can be done in four ways: live video (synchronous), store-and-forward (asynchronous), remote patient monitoring, and mobile health. Phone calls have also been studied for managing long-term health problems. Research shows phone care can be as good as seeing a doctor in person, though more study is needed.

Store and forward

Store-and-forward telemedicine means collecting medical data like medical images or biosignals and sending it to a doctor when it’s convenient. Both the patient and doctor don’t need to be online at the same time. Dermatology, radiology, and pathology often use this method. A good medical record, especially in electronic form, is important. The doctor looks at the information and patient history instead of doing an exam.

Remote monitoring

Remote monitoring lets doctors watch over patients from far away using special devices. This is helpful for long-term health problems like heart disease, diabetes, or asthma. It can work as well as visiting a doctor, makes patients happier, and might save money. Examples include home dialysis, better joint care, and diabetes management using tools that send information from home.

Real-time interactive

Electronic consultations let patients and doctors talk live. Videoconferencing is used in many medical areas for diagnosing, giving advice, and checking on patients.

Videotelephony

Main article: Videotelephony

Videotelephony is technology that lets people see and hear each other while talking from far away. In the past, it could send still pictures every few seconds over regular phone lines.

Today, videotelephony helps the deaf and speech-impaired use sign language with a video relay service. It’s also useful for people who can’t move well mobility issues or live far away and need telemedical or tele-educational help.^{[AI-retrieved source]}

Categories

Emergency care

Common daily emergency telemedicine is performed by SAMU Regulator Physicians in France, Spain, Chile, and Brazil. Aircraft and maritime emergencies are also handled by SAMU centres in Paris, Lisbon and Toulouse.

Emergency telehealth is also gaining acceptance in the United States. There are several ways to practice it, including TeleTriage, TeleMSE, and ePPE.

An example of telehealth in the field is when EMS arrives on scene of an incident and is able to take an EKG that is then sent directly to a physician at the hospital to be read, allowing for instant care and management.

Telenursing

Main article: Telenursing

Telenursing refers to the use of telecommunications and information technology to provide nursing services when there is a distance between patient and nurse. It is part of telehealth and connects with other medical applications, such as telediagnosis, teleconsultation, and telemonitoring.

Telenursing is growing in many countries because it can reduce health care costs, help an aging population, and cover distant, rural areas. It may help solve shortages of nurses, reduce travel time, and keep patients out of hospital. Telenurses often report greater job satisfaction.

In Australia, in January 2014, Melbourne tech startup Small World Social worked with the Australian Breastfeeding Association to create the first hands-free breastfeeding Google Glass application for new mothers. The application, named Google Glass Breastfeeding app trial, allows mothers to nurse their baby while viewing instructions about breastfeeding or calling a lactation consultant. The trial ended in Melbourne in April 2014, and all participants were breastfeeding confidently.

Telepalliative care

Palliative care helps people with serious illnesses improve their quality of life and reduce suffering. Telehealth is being used more in palliative care, called telepalliative care. It uses video conferencing or messaging for follow-up, or digital symptom assessments. Telepalliative care can help patients stay at home and feel safer. It may also make health care more efficient and improve teamwork among health care workers.

However, using telehealth for palliative care can be challenging. Palliative care involves many different professionals and patients with diverse needs. Some tools for reporting symptoms may not capture complex feelings. Health care workers may also feel uncomfortable providing emotional care remotely. To make telepalliative care work best, it should include users in the design process.

Telepharmacy

Main article: Telepharmacy

Telepharmacy is the delivery of pharmaceutical care using telecommunications to patients who cannot meet a pharmacist in person. It includes monitoring drug therapy, patient counseling, and prior authorization for prescription drugs. Telepharmacy allows patients in remote areas to receive pharmacy services, improving access to care. Health outcomes are similar when pharmacy services are delivered by telepharmacy compared to traditional methods.

Telepsychiatry

Teledentistry

Main article: Teledentistry

Teledentistry uses information technology and telecommunications for dental care, consultation, education, and public awareness.

Teleaudiology

Main article: Tele-audiology

Tele-audiology uses telehealth to provide audiological services. It was first used by Gregg Givens in 1999 at East Carolina University in North Carolina, US.

Teleneurotherapy

Teleneurotherapy uses computers and communications technology to deliver neurotherapy remotely. It uses physical stimuli like sounds and light to alter brain activity. Research shows that teleneurotherapy may help treat neurological conditions. Measurable changes in brain structure can appear within 2-3 months of use.

Teleneurology

Teleneurology uses mobile technology to provide neurological care from a distance, including for stroke and movement disorders like Parkinson's disease. It allows better access to care for people around the world. People with Parkinson's disease often prefer to connect with a remote specialist rather than their local clinician. Home care via teleneurology is convenient but requires internet access. Research shows that teleneurology can be as effective as in-person visits for some conditions.

Teleneurosurgery

Telemedicine in neurosurgery was historically used for follow-up visits by patients who had to travel far. In recent years, it has also been used for remote ICU rounding and evaluating stroke patients. Since the COVID-19 pandemic, telemedicine use has increased across all areas of neurosurgery. It is now used not just for follow-up, but also for seeing new patients and established patients, whether or not they had surgery. Telemedicine is also used in research for clinical trials involving neurosurgical patients.

Teleneuropsychology

Teleneuropsychology uses telehealth/videoconference technology to give neuropsychological tests remotely. These tests evaluate cognitive status for people with known or suspected brain disorders. Studies show that remote administration of these tests gives results similar to in-person evaluations.

Telenutrition

Telenutrition uses video conferencing to provide online consultation by a nutritionist or dietician. Patients upload health data, and the nutritionist sets goals and monitors progress through follow-up consultations. Telenutrition can help elderly or bedridden patients consult from home. It has been found feasible and trusted by patients, especially during the COVID-19 pandemic.

Telerehabilitation

Main article: Telerehabilitation

Telerehabilitation delivers rehabilitation services over the Internet. It includes clinical assessment and clinical therapy. It is used in neuropsychology, speech–language pathology, audiology, occupational therapy, and physical therapy. Telerehabilitation helps people who cannot travel to a clinic due to disability or distance. It also allows experts to consult from afar.

Telerehabilitation is mostly visual, using webcams, videoconferencing, phone lines, videophones, and web applications. It is commonly used for neuropsychological rehabilitation, fitting equipment like wheelchairs, and speech-language pathology. Research focuses on proving its effectiveness and developing new data systems. The National Institute on Disability and Rehabilitation Research supports telerehabilitation research in the United States.

Only a few health insurers in the United States and some Medicaid programs reimburse for telerehabilitation. If research shows it is as effective as in-person care, more insurers may cover it.

Teletrauma care

Telemedicine improves care in trauma situations. It can be used for trauma triage, allowing trauma specialists to assess injuries and decide on evacuation from a distance. It is also used in intensive care unit (ICU) rounds to reduce infection spread, with teams conducting rounds remotely using video-conferencing. Telemedicine is used for trauma education, delivering lectures worldwide. Surgeons can also observe and consult on surgeries from remote locations using video conferencing.

Telecardiology

ECGs, or electrocardiographs, can be sent using telephone and wireless methods. Willem Einthoven, the inventor of the ECG, tested transmission via telephone because the hospital would not let him move patients. In 1906, he found a way to send the data directly to his lab.

Transmission of ECGs

One of the oldest telecardiology systems was set up in Gwalior, India, in 1975 at GR Medical College. It allowed wireless transmission of ECGs from moving vans or homes to a central station. The system used frequency modulation to reduce noise and could also use telephone lines. This helped bring medical aid to remote areas.

Wireless ambulatory ECG technology now includes smartphones and Apple Watches for at-home cardiac monitoring.

Teleradiology

Main article: Teleradiology

Teleradiology sends radiographic images (X-rays, CT, MR, PET/CT, SPECT/CT, MG, US...) from one place to another. It needs an image-sending station, a transmission network, and a receiving station. The most common setup is two computers connected via the Internet. Teleradiology is the most popular use of telemedicine, accounting for at least 50% of all telemedicine usage.

Telepathology

Main article: Telepathology

Telepathology practices pathology from a distance using telecommunications technology. It was coined by pathologist Ronald S. Weinstein, M.D., in 1986. The first sustainable clinical telepathology service began in Norway in 1989. Telepathology is used for diagnosis, education, and research. It works well in developed countries with digital pathology, but analog methods are still used in some developing countries.

Teledermatology

Main article: Teledermatology

Teledermatology provides dermatology consultations from a distance using audio, visual, and data communication. It improves efficiency, access to care, and patient satisfaction.

Teleophthalmology

Main article: Teleophthalmology

Teleophthalmology delivers eye care using digital equipment and telecommunications. It helps provide care to remote areas, screen for diseases, and support distant learning. In Mizoram, India, it helped over 10,000 patients between 2011 and 2015, saving travel costs.

Telesurgery

Main article: Remote surgery

Remote surgery allows a doctor to perform surgery from a different location. It combines robotics, high-speed data connections, and telecommunications. While robotic surgery is common, remote surgery lets surgeons work from far away. It promises to make specialized care available worldwide. A key challenge is the speed and reliability of the communication system between surgeon and patient.

Major developments

Telehealth is a new way of providing healthcare using modern communication tools instead of face-to-face visits. Unlike traditional healthcare, which has rules set by laws, telehealth is newer and many places are now making rules to guide its use. For example, in New Zealand, the medical council has statements about telehealth, showing they see its growing importance.

Telehealth used to be mostly for special cases, but now it is becoming more common for everyday care. This helps people in rural areas who often have to travel far for healthcare because there are fewer doctors and clinics there. With telehealth, doctors can talk to patients using wireless technology, making it easier for them to get care without long trips. However, this needs both the doctor and patient to have internet and feel comfortable using technology, which can be hard for some people.

During the COVID-19 pandemic, the use of telehealth grew a lot. Many patients and doctors were happy with this change.

Better technology has also helped telehealth grow. New wireless devices let patients check their own health and follow treatment plans more closely. This also helps doctors use better tools for treating patients, like in surgeries. As technology keeps improving, telehealth can help meet the needs of more people, especially with an ageing population.

Licensing

U.S. licensing and regulatory issues

In the United States, doctors need special permission, called a license, to provide telehealth care in different states. This can be hard because each state has its own rules. Some states have exceptions, but often doctors must take many steps, like paying fees, taking tests, and traveling for interviews, even if they never meet patients in person.

In 2008, a law called the Ryan Haight Act was passed, requiring a face-to-face meeting or a proper telehealth visit before a doctor can send a prescription.

Some state medical boards have not always supported telehealth. For example, in 2012, electronic visits were not allowed in Idaho, and a doctor was in trouble for prescribing medicine online. Later, in 2015, Idaho changed its laws to allow electronic visits. Also in 2015, a company named Teladoc argued with the Texas Medical Board about rules requiring initial in-person visits.

EU licensing and regulatory issues

In the European Union, rules for telehealth mainly depend on the country where the service is based.

Major implications and impacts

Telehealth uses technology to help doctors and nurses give care from far away. It can make health care better, easier to reach, and more personal for many people.

Telehealth helps with health education, letting people learn about staying healthy in their own homes. This is very useful in places with fewer doctors and hospitals. For example, mobile phone apps can help people watch their health every day. In some countries, special apps have helped new mothers learn how to care for their babies.

Using telehealth can improve the quality of health care. It can help keep people safe during sickness outbreaks and make it easier for those who feel nervous in doctor’s offices. However, some people worry about keeping health information private and making sure everyone can use these tools. Telehealth can also help save money and make care easier to reach, especially for people who cannot travel far. It has been especially helpful during big health challenges, like when many people needed care but could not leave their homes.

Limitations and restrictions

Telehealth is helpful, but it has some limits. It can’t replace a doctor seeing a patient in person for certain checks, like diagnostics, rehabilitation, or mental health. Some treatments, like for breathing problems, need a doctor nearby.

There are also rules that need to change for telehealth. When doctors and patients are far apart, it’s hard to know which laws apply. This makes things complicated, especially when crossing borders. For example, in America, Medicare only pays for telehealth in certain areas. Not all insurers pay for telehealth, so patients and doctors need to check. There are also questions about who is responsible if something goes wrong during a telehealth visit.

Telehealth works best with a good relationship between the doctor and patient. Without this, it may not work well. There are also costs for equipment and training. Some treatments can’t start right away through telehealth. Plus, not everyone has good internet or devices, which makes it unfair for some people.

Ethical issues

See also: Informed consent and Medical ethics

Informed consent matters for telehealth. We must make sure patients know how their information is used and kept safe. This is because of problems like mistakes in sending information or security issues. It’s good to talk about this in person first and have backup plans if technology fails. More people might see the patient’s information, so patients should know who can see it and how it is protected.

State of the market

The use of telehealth services depends on several factors, such as how well regular health services meet patient needs, government and insurer policies about paying for telehealth, and medical licensing rules.

Many experts believe the telehealth market will grow because more people want remote medical care. In the United States, many people say they would use telehealth. Many companies are working to become leaders in this field. During the COVID-19 pandemic, the use of telehealth services in the U.S. increased sharply.

In the UK, government plans aim to extend telehealth and telecare to help many people. In Switzerland, the University Hospital of Zurich has provided online medical advice since 1999. Doctors there answer questions from people about their health, helping them understand their symptoms better. This service has helped many people discuss health concerns.

Developing countries

For developing countries, telemedicine and eHealth can be the only way to get healthcare in faraway places. In many parts of Africa, there are not enough doctors or good hospitals, especially in rural areas. This makes it hard for people to get the care they need. But telemedicine and eHealth can help, even though it is difficult because many areas do not have good phone or internet services, and sometimes even electricity.

In India, many people in rural areas do not have good access to doctors. Because of this, the government started using telemedicine to connect people with doctors from far away. In 2020, during the COVID-19 pandemic, new rules were made to support telemedicine. A service called eSanjeevani was started, allowing doctors to talk to other doctors and patients online. It has already helped millions of people.

In Sub-Saharan Africa, some areas are changing fast with new technology and better internet. But people in remote places still struggle to get healthcare, sometimes having to travel for hours to reach a hospital. Telemedicine could help these people get care without long journeys.

Some projects use satellite internet to bring telemedicine to rural areas. For example, the SAHEL project started in Kenya and Senegal in 2010. It uses solar-powered internet stations in villages, helping local nurses talk to doctors far away for training and advice. This lets people get medical help without traveling far. Similar projects, like SATMED, use satellites to connect remote clinics to doctors and hospitals, especially in places where roads are hard to use during rainy seasons.

History

The history of telehealth is linked to the growth of technology and society. People have always wanted to send messages far away, using things like torches, optical telegraphy, and wireless transmission. Early telehealth used telephones and radios, which were later improved with videotelephony and special devices for home care. Telehealth began to help people in places far from doctors, especially in rural areas.

In the 21st century, the internet and portable devices changed healthcare. These tools made it easier for doctors to talk to patients and share information from far away.

Earliest instances

Even in ancient times, people wanted care when they couldn’t see a doctor in person. In places like Rome and Africa, people used simple signals like smoke signals to share important health news. During the Bubonic Plague, people used lights and fires to send messages, though these were not advanced technology. These early methods show how people have always tried to connect when they couldn’t meet face-to-face.

1800s to early 1900s

As technology improved, so did ways to give healthcare from far away. In 1876, Alexander Graham Bell used his new telephone to get help after spilling acid. In 1879, a doctor diagnosed a child by telephone during the night. During the American Civil War, telegraphs helped send medical information and supplies.

In the early 1900s, doctors used telephones to stay in touch with patients and other doctors. By the 1930s, radios became important, especially in places like Alaska and Australia. During World War II, radios helped send medical teams by helicopter. Services like the Royal Flying Doctor Service in Australia used radios to reach people living far away.

Mid-1900s to 1980s

When NASA began sending astronauts into space, they needed ways to monitor health from far away. They built special systems to check things like heart rate and blood pressure. These ideas later helped create telehealth for everyone.

Hospitals also began using telehealth. For example, after a plane accident in 1960, doctors in Boston used video links to help people at the airport. By the 1970s, schools and health departments started funding telehealth projects across the United States.

1980s to 1990s – maturation and renaissance

In the 1980s and 1990s, telehealth grew but still wasn’t common in everyday care. Hospitals started their own telehealth programs, and NASA helped connect health services in developing countries.

At-home virtual care

In the 1990s, telehealth began to include care at home. Doctors could check on patients after surgery or monitor people with health devices. For example, some devices watched sleep patterns or helped people with memory problems stay safe. These tools let doctors help patients without them staying in the hospital.

2000s to present

With faster Internet and more devices like phones and computers, telehealth grew quickly. New technologies, like smart home devices, made it easier for doctors to help patients from far away.

During the COVID-19 pandemic, telehealth became very important. Doctors used video calls to check on patients around the world. Many people found telehealth helpful, and it became a key part of healthcare. Universities now teach future doctors how to use telehealth, and experts believe it can help make healthcare more fair and available to everyone.

Telehealth versus in-person on treatment and follow-up visits study

A study from 2023 looked at over 1.5 million adult patients in the U.S. It found that patients who had their first visit using telehealth were less likely to get prescriptions, lab tests, or imaging than those who saw a doctor in person. However, these telehealth patients were more likely to return for follow-up visits in person. Out of over 2 million primary care visits, about half were in-office, one-third were telephone calls, and one-fifth were video calls. Office visits resulted in more prescriptions, lab tests, and imaging compared to video or telephone visits. Patients who used telephone or video calls were more likely to come back for follow-up visits than those who had office visits. The study also noted small differences in emergency department visits and hospital stays for those using telehealth, but these were not very large. The study had some limits, like not being able to apply the results to all healthcare settings or patients without insurance.

Privacy and confidentiality regulations

Telehealth services in the United States follow special rules to keep health information safe. These rules are part of the Health Insurance Portability and Accountability Act (HIPAA). They protect private health details, whether a doctor sees a patient in person or uses technology to talk from far away.

During a big health problem, some rules were relaxed so people could use easier tools to talk to doctors. But those relaxed rules ended, and now doctors must use safer tools that follow the HIPAA rules. These rules help keep everyone’s health information private and secure when using telehealth.