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 used as if they mean the same thing, but they have some differences. Telemedicine mainly refers to remote clinical services like diagnosing and monitoring health problems. Telehealth, however, is broader. It includes not just clinical care, but also preventative and educational health services, as well as administrative tasks.

Different groups define these terms 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 terms interchangeably. The term eHealth is also related and is used in some places 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.

A recent study identified three major barriers to the adoption of telemedicine in emergency and critical care units. They include:

Regulatory challenges related to the difficulty and cost of obtaining licensure across multiple states, malpractice protection and privileges at multiple facilities
Financial barriers including a lack of acceptance and reimbursement by government payers and some commercial insurance carriers, which places the investment burden squarely upon the hospital or healthcare system.
Cultural barriers occurring from the lack of desire, or unwillingness, of some physicians to adapt clinical paradigms for telemedicine applications.

Emergency telehealth is also gaining acceptance in the United States. There are several modalities currently being practiced that include but are not limited to 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 in order to provide nursing services in health care whenever a large physical distance exists between patient and nurse, or between any number of nurses. As a field, it is part of telehealth, and has many points of contact with other medical and non-medical applications, such as telediagnosis, teleconsultation, telemonitoring, etc.

Telenursing is achieving significant growth rates in many countries due to several factors: the preoccupation with reducing the costs of health care, an increase in the aging and chronically ill population, and the increase in coverage of health care to distant, rural, small or sparsely populated regions. Among its benefits, telenursing may help solve increasing shortages of nurses, reduce distances and travel time, and keep patients out of hospital. A greater degree of job satisfaction has been registered among telenurses.

In Australia, during January 2014, Melbourne tech startup Small World Social collaborated 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 common breastfeeding issues (latching on, posture, etc.) or call a lactation consultant via a secure Google Hangout, who can view the issue through the mother's Google Glass camera. The trial was successfully concluded in Melbourne in April 2014, and 100% of participants were breastfeeding confidently.

Telepalliative care

Palliative care is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. In the past, palliative care was a disease specific approach, but today the World Health Organization (WHO) takes a broader approach suggesting that palliative care should be applied as early as possible to any chronic and fatal illness. As in many aspects of health care, telehealth is increasingly being used in palliative care and is often referred to as telepalliative care. The types of technology applied in telepalliative care are typically telecommunication technologies, such as video conferencing or messaging for follow-up, or digital symptom assessments through digital questionnaires generating alerts to health care professionals. Telepalliative care has been shown to be a feasible approach to deliver palliative care among patients, caregivers and health care professionals. Telepalliative care can provide an added support system that enable patients to remain at home through self-reporting of symptoms and tailoring care to specific patients. Studies have shown that the use of telehealth in palliative care is mostly well received by patients, and that telepalliative care may improve access to health care professionals at home and enhance feelings of security and safety among patients receiving palliative care. Further, telepalliative care may enable more efficient utilization of healthcare resources, promotes collaboration between different levels of healthcare, and makes healthcare professionals more responsive to changes in patients' condition.

Challenging aspects of the use of telehealth in palliative care have also been described. Generally, palliative care is a diverse medical specialty, involving interdisciplinary professionals from different professional traditions and cultures, delivering care to a heterogenous cohort of patients with diverse diseases, conditions and symptoms. This makes it a challenge to develop telehealth that is suitable for all patients and in all contexts of palliative care. Some of the barriers to telepalliative care relate to inflexible reporting of complex and fluctuating symptoms and circumstances using electronic questionnaires. Further, palliative care emphasizes a holistic approach that should address existential, spiritual and mental distress related to serious illness. However, few studies have included the self-reporting of existential or spiritual concerns, emotions, and well-being. Healthcare professionals may also be uncomfortable providing emotional or psychological care remotely. Palliative care has been characterized as high-touch rather than high-tech, limiting the interest in applying technological advancements when developing interventions. To optimize the advantages and minimize the challenges with the use of telehealth in home-based palliative care, future research should include users in the design and development process. Understanding the potential of telehealth to support therapeutic relationships between patients and health care professionals and being aware of the possible difficulties and tensions it may create are critical to its successful and acceptable use.

Telepharmacy

Main article: Telepharmacy

Telepharmacy is the delivery of pharmaceutical care via telecommunications to patients in locations where they may not have direct contact with a pharmacist. It is an instance of the wider phenomenon of telemedicine, as implemented in the field of pharmacy. Telepharmacy services include drug therapy monitoring, patient counseling, prior authorization and refill authorization for prescription drugs, and monitoring of formulary compliance with the aid of teleconferencing or videoconferencing. Remote dispensing of medications by automated packaging and labeling systems can also be thought of as an instance of telepharmacy. Telepharmacy services can be delivered at retail pharmacy sites or through hospitals, nursing homes, or other medical care facilities. This approach allows patients in remote or underserved areas to receive pharmacy services that would otherwise be unavailable to them, enhancing access to care and ensuring continuity in medication management. Health outcomes appear similar when pharmacy services are delivered by telepharmacy compared to traditional service delivery.

The term can also refer to the use of videoconferencing in pharmacy for other purposes, such as providing education, training, and management services to pharmacists and pharmacy staff remotely.

Telepsychiatry

Teledentistry

Main article: Teledentistry

Teledentistry is the use of information technology and telecommunications for dental care, consultation, education, and public awareness in the same manner as telehealth and telemedicine.

Teleaudiology

Main article: Tele-audiology

Tele-audiology (or teleaudiology) is the utilization of telehealth to provide audiological services and may include the full scope of audiological practice. This term was first used by Gregg Givens in 1999 in reference to a system being developed at East Carolina University in North Carolina, US.

Teleneurotherapy

Teleneurotherapy uses computers and communications technology to deliver neurotherapy remotely. Organisms receive physical stimuli, such as sounds (through mechanoreceptors and mitochondria across different organ systems) and light (through photoreceptors located in the retina and mitochondria) that alter neuronal activity in specific brain zones. Research indicates that systematic physical stimuli produced by standard electronic devices, such as tablets with headphones, may treat online injured nervous systems by modulating neuronal plasticity. Evidence suggests that teleneurotherapy may elevate neurological treatment if it considers the treating effect of a systematic abiotic impact of physical forces with key parameters of the mother-fetus interaction. Recent research implemented the APIN method (see above) in the online treatment of patients with different neurological conditions, which showed therapeutic effects.

A review of the scientific literature has shown that measurable neuronal structural changes due to neuroplasticity through teleneurotherapy can appear within 2-3 months of such systematic impacts. The systematic effect of cognitive load from computer work, with a total training duration of 16 h (a few hours of weekly exercise), can significantly affect brain structure and function.

Teleneurology

Teleneurology describes the use of mobile technology to provide neurological care remotely, including care for stroke, movement disorders like Parkinson's disease, seizure disorders (e.g., epilepsy), etc. The term teleneurology implies remote education, diagnostic assistance, and consultation, while it does not involve non-invasive remote targeted delivery of an energy stimulus to a specific neurological zone in the body to alter neuronal activity. The use of teleneurology gives us the opportunity to improve health care access for billions around the globe, from those living in urban locations to those in remote, rural locations. Evidence shows that individuals with Parkinson's disease prefer personal connection with a remote specialist to their local clinician. Such home care is convenient but requires access to and familiarity with the Internet. A 2017 randomized controlled trial of "virtual house calls" or video visits with individuals diagnosed with Parkinson's disease evidences patient preference for the remote specialist vs their local clinician after one year. Teleneurology for patients with Parkison's disease is found to be cheaper than in person visits by reducing transportation and travel time A recent systematic review by Ray Dorsey et al. describes both the limitations and potential benefits of teleneurology in improving care for patients with chronic neurological conditions, especially in low-income countries. White, well-educated and technologically savvy people are the biggest consumers of telehealth services for Parkinson's disease. as compared to ethnic minorities in the US.

Teleneurosurgery

Telemedicine in neurosurgery was historically primarily used for follow-up visits by patients who had to travel far to undergo surgery. In the last decade, telemedicine was also used for remote ICU rounding as well as prompt evaluation for acute ischemic stroke and administration of IV alteplase in conjunction with neurology. From the onset of the COVID-19 pandemic, there was a rapid surge in the use of telemedicine across all divisions of neurosurgery: vascular, oncology, spine, and functional neurosurgery. Not only for follow-up visits, but it has gained popularity for seeing new patients or following established patients regardless of whether they underwent surgery. Telemedicine is not limited to direct patient care only; there are a number of new research groups and companies focused on using telemedicine for clinical trials involving patients with neurosurgical diagnoses.

Teleneuropsychology

Teleneuropsychology is the use of telehealth/videoconference technology for the remote administration of neuropsychological tests. Neuropsychological tests are used to evaluate the cognitive status of individuals with known or suspected brain disorders and provide a profile of cognitive strengths and weaknesses. Through a series of studies, there is growing support in the literature showing that remote videoconference-based administration of many standard neuropsychological tests results in test findings similar to traditional in-person evaluations, thereby establishing the basis for the reliability and validity of teleneuropsychological assessment.

Telenutrition

Telenutrition refers to the use of video conferencing/ telephony to provide online consultation by a nutritionist or dietician. Patient or clients upload their vital statistics, diet logs, food pictures, etc., on a telenutrition portal that is then used by the nutritionist or dietician to analyze their current health condition. The nutritionist or dietician can then set goals for their respective clients/patients and monitor their progress regularly by follow-up consultations.

Telenutrition portals can help people seek remote consultation for themselves and/or their family. This can be extremely helpful for elderly or bedridden patients who can consult their dietician from comfort of their homes.

Telenutrition showed to be feasible, and the majority of patients trusted the nutritional televisits, in place of the scheduled but not provided follow-up visits during the lockdown of the COVID-19 pandemic.

Telerehabilitation

Main article: Telerehabilitation

Telerehabilitation (or e-rehabilitation) is the delivery of rehabilitation services over telecommunication networks and the Internet. Most types of services fall into two categories: clinical assessment (the patient's functional abilities in his or her environment) and clinical therapy. Some fields of rehabilitation practice that have explored telerehabilitation are: neuropsychology, speech–language pathology, audiology, occupational therapy, and physical therapy. Telerehabilitation can deliver therapy to people who cannot travel to a clinic because the patient has a disability or because of travel time. Telerehabilitation also allows experts in rehabilitation to engage in clinical consultation at a distance.

Most telerehabilitation is highly visual. As of 2014, the most commonly used mediums are webcams, videoconferencing, phone lines, videophones, and webpages containing rich web applications. The visual nature of telerehabilitation technology limits the types of rehabilitation services that can be provided. It is most widely used for neuropsychological rehabilitation, fitting of rehabilitation equipment such as wheelchairs, braces, or artificial limbs, and in speech-language pathology. Rich web applications for neuropsychological rehabilitation (cognitive rehabilitation) of cognitive impairment (from many etiologies) were first introduced in 2001. This endeavor has expanded as a teletherapy application for cognitive skills enhancement programs for school children. Tele-audiology (hearing assessments) is a growing application. Physical therapy and psychology interventions delivered via telehealth may result in similar outcomes as those delivered in person for a range of health conditions.

Two important areas of telerehabilitation research are (1) demonstrating equivalence of assessment and therapy to in-person assessment and therapy and (2) building new data collection systems to digitize information that a therapist can use in practice. Ground-breaking research in telehaptics (the sense of touch) and virtual reality may broaden the scope of telerehabilitation practice in the future.

In the United States, the National Institute on Disability and Rehabilitation Research's (NIDRR) supports research and the development of telerehabilitation. NIDRR's grantees include the "Rehabilitation Engineering and Research Center" (RERC) at the University of Pittsburgh, the Rehabilitation Institute of Chicago, the State University of New York at Buffalo, and the National Rehabilitation Hospital in Washington, D.C. Other federal funders of research are the Veterans Health Administration, the Health Services Research Administration in the US Department of Health and Human Services, and the Department of Defense. Outside the United States, excellent research is conducted in Australia and Europe.

Only a few health insurers in the United States, and about half of Medicaid programs, reimburse for telerehabilitation services. If the research shows that teleassessments and teletherapy are equivalent to clinical encounters, it is more likely that insurers and Medicare will cover telerehabilitation services.

Teletrauma care

Telemedicine can be utilized to improve the efficiency and effectiveness of care delivery in a trauma environment. Examples include:

Telemedicine for trauma triage: using telemedicine, trauma specialists can interact with personnel on the scene of a mass casualty or disaster situation via the internet using mobile devices to determine the severity of injuries. They can provide clinical assessments and determine whether those injured must be evacuated for necessary care. Remote trauma specialists can provide the same quality of clinical assessment and plan of care as a trauma specialist located physically with the patient.

Telemedicine for intensive care unit (ICU) rounds: Telemedicine is also being used in some trauma ICUs to reduce the spread of infections. Rounds are usually conducted at hospitals across the country by a team of approximately ten or more people including attending physicians, fellows, residents, and other clinicians. This group usually moves from bed to bed in a unit, discussing each patient. This aids in the transition of care for patients from the night shift to the morning shift but also serves as an educational experience for new residents to the team. A new approach features the team conducting rounds from a conference room using a video-conferencing system. The trauma attending, residents, fellows, nurses, nurse practitioners, and pharmacists are able to watch a live video stream from the patient's bedside. They can see the vital signs on the monitor, view the settings on the respiratory ventilator, and/or view the patient's wounds. Video-conferencing allows remote viewers to conduct two-way communication with clinicians at the bedside.

Telemedicine for trauma education: some trauma centers are delivering trauma education lectures to hospitals and health care providers worldwide using video conferencing technology. Each lecture provides fundamental principles, first-hand knowledge, and evidenced-based methods for critical analysis of established clinical practice standards, and comparisons to newer advanced alternatives. The various sites collaborate and share their perspective based on location, available staff, and available resources.

Telemedicine in the trauma operating room: trauma surgeons are able to observe and consult on cases from a remote location using video conferencing. This capability allows the attending to view the residents in real time. The remote surgeon has the capability to control the camera (pan, tilt, and zoom) to get the best angle of the procedure while at the same time providing expertise in order to provide the best possible care to the patient.

Telecardiology

ECGs, or electrocardiographs, can be transmitted using telephone and wireless. Willem Einthoven, the inventor of the ECG, actually did tests with the transmission of ECG via telephone lines. This was because the hospital did not allow him to move patients outside the hospital to his laboratory for testing of his new device. In 1906, Einthoven came up with a way to transmit the data from the hospital directly to his lab.

Transmission of ECGs

One of the oldest known telecardiology systems for teletransmissions of ECGs was established in Gwalior, India, in 1975 at GR Medical College by Ajai Shanker, S. Makhija, P.K. Mantri using an indigenous technique for the first time in India.

This system enabled wireless transmission of ECG from the moving ICU van or the patients home to the central station in ICU of the department of Medicine. Transmission using wireless was done using frequency modulation which eliminated noise. Transmission was also done through telephone lines. The ECG output was connected to the telephone input using a modulator that converted ECG into high-frequency sound. At the other end a demodulator reconverted the sound into ECG with a good gain accuracy. The ECG was converted to sound waves with a frequency varying from 500 Hz to 2500 Hz with 1500 Hz at baseline.

This system was also used to monitor patients with pacemakers in remote areas. The central control unit at the ICU was able to correctly interpret arrhythmia. This technique helped medical aid reach in remote areas.

In addition, electronic stethoscopes can be used as recording devices, which is helpful for purposes of telecardiology. There are many examples of successful telecardiology services worldwide.

In Pakistan, three pilot projects in telemedicine were initiated by the Ministry of IT & Telecom, Government of Pakistan (MoIT) through the Electronic Government Directorate in collaboration with Oratier Technologies (a pioneer company within Pakistan dealing with healthcare and HMIS) and PakDataCom (a bandwidth provider). Three hub stations through were linked via the Pak Sat-I communications satellite, and four districts were linked with another hub. A 312 Kb link was also established with remote sites and 1 Mbit/s bandwidth was provided at each hub. Three hubs were established: the Mayo Hospital (the largest hospital in Asia), JPMC Karachi, and Holy Family Rawalpindi. These 12 remote sites were connected and an average of 1,500 patients were treated per month per hub. The project was still running smoothly after two years.

Wireless ambulatory ECG technology, moving beyond previous ambulatory ECG technology such as the Holter monitor, now includes smartphones and Apple Watches, which can perform at-home cardiac monitoring and send the data to a physician via the Internet.

Teleradiology

Main article: Teleradiology

Teleradiology is the ability to send radiographic images (X-rays, CT, MR, PET/CT, SPECT/CT, MG, US...) from one location to another. For this process to be implemented, three essential components are required: an image-sending station, a transmission network, and a receiving-image review station. The most typical implementation is two computers connected via the Internet. The computer at the receiving end will need a high-quality display screen that has been tested and cleared for clinical purposes. Sometimes the receiving computer will have a printer for convenience.

The teleradiology process begins at the image-sending station. The radiographic image and a modem or other connection are required for this first step. The image is scanned and then sent via the network connection to the receiving computer.

Today's high-speed broadband-based Internet enables the use of new technologies for teleradiology: the image reviewer can now have access to distant servers in order to view an exam. Therefore, they do not need particular workstations to view the images; a standard personal computer (PC) and digital subscriber line (DSL) connection is enough to reach Keosys' central server. No particular software is necessary on the PC, and the images can be reached from anywhere in the world.

Teleradiology is the most popular use for telemedicine and accounts for at least 50% of all telemedicine usage.

Telepathology

Main article: Telepathology

Telepathology is the practice of pathology at a distance. It uses telecommunications technology to facilitate the transfer of image-rich pathology data between distant locations for the purposes of diagnosis, education, and research. The performance of telepathology requires that a pathologist selects the video images for analysis and rendering diagnoses. The use of "television microscopy", the forerunner of telepathology, did not require that a pathologist have physical or virtual "hands-on" involvement in the selection of microscopic fields of view for analysis and diagnosis.

A pathologist, Ronald S. Weinstein, M.D., coined the term "telepathology" in 1986. In an editorial in a medical journal, Weinstein outlined the actions that would be needed to create remote pathology diagnostic services. He and his collaborators published the first scientific paper on robotic telepathology. Weinstein was also granted the first U.S. patents for robotic telepathology systems and telepathology diagnostic networks. Weinstein is known to many as the "father of telepathology". In Norway, Eide and Nordrum implemented the first sustainable clinical telepathology service in 1989. This is still in operation, decades later. A number of clinical telepathology services have benefited many thousands of patients in North America, Europe, and Asia.

Telepathology has been successfully used for many applications, including the rendering histopathology tissue diagnoses at a distance, for education and research. Although digital pathology imaging, including virtual microscopy, is the mode of choice for telepathology services in developed countries, analog telepathology imaging is still used for patient services in some developing countries.

Teledermatology

Main article: Teledermatology

Teledermatology allows dermatology consultations over a distance using audio, visual and data communication, and has been found to improve efficiency, access to specialty care, and patient satisfaction. Applications comprise health care management such as diagnoses, consultation and treatment as well as (continuing medical) education. The dermatologists Perednia and Brown were the first to coin the term teledermatology in 1995, where they described the value of a teledermatologic service in a rural area underserved by dermatologists.

Teleophthalmology

Main article: Teleophthalmology

Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology. Today, applications of teleophthalmology encompass access to eye specialists for patients in remote areas, ophthalmic disease screening, diagnosis and monitoring; as well as distant learning. Teleophthalmology may help reduce disparities by providing remote, low-cost screening tests such as diabetic retinopathy screening to low-income and uninsured patients. In Mizoram, India, a hilly area with poor roads, between 2011 and 2015, teleophthalmology provided care to over 10,000 patients. These patients were examined by ophthalmic assistants locally but surgery was done on appointment after the patient images were viewed online by eye surgeons in the hospital 6–12 hours away. Instead of an average five trips for say, a cataract procedure, only one was required for surgery alone as even post-op care like removal of stitches and appointments for glasses was done locally. There were large cost savings in travel as well.

In the United States, some companies allow patients to complete an online visual exam and within 24 hours receive a prescription from an optometrist valid for eyeglasses, contact lenses, or both. Some US states such as Indiana have attempted to ban these companies from doing business.

Telesurgery

Main article: Remote surgery

Remote surgery (also known as telesurgery) is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It is a form of telepresence. Remote surgery combines elements of robotics, cutting-edge telecommunications such as high-speed data connections, telehaptics and elements of management information systems. While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery.

Remote surgery is remote work for surgeons, where the physical distance between the surgeon and the patient is immaterial. It promises to allow the expertise of specialized surgeons to be available to patients worldwide, without the need for patients to travel beyond their local hospital.

Remote surgery or telesurgery is performance of surgical procedures where the surgeon is not physically in the same location as the patient, using a robotic teleoperator system controlled by the surgeon. The remote operator may give tactile feedback to the user. Remote surgery combines elements of robotics and high-speed data connections. A critical limiting factor is the speed, latency and reliability of the communication system between the surgeon and the patient, though trans-Atlantic surgeries have been demonstrated.

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. In the United States, the number of telehealth visits jumped from about 1.4 million each quarter before the pandemic to 35 million in a quarter during 2020. In the UK, the use of telehealth by doctors rose from 20-30% before the pandemic to nearly 80% by early 2021. 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. A study in 2023 showed that telehealth was very helpful for patients and doctors who used it for surgery consultations. 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 difficult because each state has its own rules. Some states have exceptions, but often doctors must go through a lot of 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

While many areas of medicine want to use telehealth a lot, there are some problems and limits. For example, telehealth can’t fully replace a doctor seeing a patient in person, especially for checking things like diagnostics, rehabilitation, or mental health. It’s not safe to do certain checks or treatments, like for breathing problems or chest pain, without a doctor being there.

There are also rules and laws that need to catch up with telehealth. When doctors and patients are far apart, it’s hard to know which laws apply. This makes things complicated, especially when crossing state or country borders. For example, in America, Medicare only pays for telehealth in certain areas where doctors are hard to find. Not all insurers pay for telehealth yet, so patients and doctors need to check carefully. There are also questions about who is responsible if something goes wrong during a telehealth visit. These rules need to be clearer as telehealth grows.

Telehealth can help patients manage their health, but it needs a good relationship between the doctor and patient. Without this, the benefits of telehealth may not work well. There are also costs for equipment and training, and sometimes less human contact can lead to mistakes. Some treatments also can’t start right away through telehealth. Plus, not everyone has good internet or devices to use telehealth, which makes it unfair for some people.

Ethical issues

See also: Informed consent and Medical ethics

Informed consent is important in telehealth. Because of possible problems like mistakes in sending information, security issues, or problems storing data, it’s important to make sure patients understand how their information will be used and protected. It might be best to talk about this in person first and have backup plans in case technology fails. When using telehealth, more people are involved, like the technology providers, so patients need to know who will see their information and how it will be kept safe.

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 that might limit certain types of telehealth consultations.

Many experts believe the telehealth market will grow because more people want remote medical care. In the United States, nearly three-quarters of people say they would use telehealth. Many companies and new startups 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 reach three million people over several years. In Switzerland, the University Hospital of Zurich has provided online medical advice since 1999. Doctors there answer many questions from people about their health, helping them understand their symptoms better and get personalized information. This service has helped many people discuss health concerns they might feel shy about in person.

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 tied to the development of technology and society. People have always wanted to send messages far away, using things like torches, optical telegraphy, and wireless transmission. Early forms of 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 make sure that private health details are protected, no matter if a doctor sees a patient in person or uses technology to talk from far away.

During a big health problem, allowed 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 make sure that everyone’s health information stays private and secure when using telehealth.