Today, telehealth encompasses four distinct applications. These are commonly known as live video, store-and-forward, remote patient monitoring, and mobile health. Explore each modality in detail to learn more.
Live Video
Live, two-way interaction between a person and a provider using audiovisual telecommunications technology. This type of service is also referred to as “real-time” and may serve as a substitute for an in-person encounter when it is not available.
Our micro-documentary shows an instance where live video telehealth can be a lifesaving technology.
Live video can be used for consultative, diagnostic, and treatment services. Video devices can include video conferencing units, peripheral cameras, videoscopes, or web cameras. Display devices include computer monitors, plasma/LED TV, LCD projectors, and even tablet computers. Video conferencing can provide cost-effective access to care for patients who are institutionalized or incarcerated.
Video conferencing has historically been the most common application of telemedicine/telehealth care, and is an effective health care and consultation tool for a variety of applications, including:
Emergency room / intensive care unit support
- Video conferencing connects emergency providers with medical specialists who otherwise would not be available for consults.
- Remote ICU monitoring programs at hospitals provide 24-hour backup, supervision, and support to ICU medical staffs by utilizing a combination of real-time video to observe patients, interactive video communications with on-site ICU providers, and digital patient monitoring equipment.
Consults
- Primary care providers can consult with medical specialists who are not available locally.
- Providers can discuss patient cases, regardless of location, and without the need for travel.
- Medical specialists can examine patients in remote locations when distance is a barrier, as is the case when patients live in rural and underserved urban areas. This includes situations where the physician needs to directly observe the patient.
- Psychiatric consults can effectively be provided through live video for individuals who do not have local access, or who may otherwise be reluctant to keep appointments in-person at a psychiatric provider’s office.
- Patients with limited mobility can receive medical consultations at home, or in their local primary care provider’s office.
- Language translators can provide video interpretation services to multiple locations, a cost-effective expansion of these programs.
Health education
- Video conferencing allows health care professionals to conduct continuing education programs with attendees in multiple locations.
- Patients can use these technologies to take disease management courses or receive other important health information.
Store-and-Forward
Electronic transmission of medical information, such as digital images, documents, and pre-recorded videos, to a practitioner, usually a specialist, who uses the information to evaluate the case or render a service outside of a real-time or live interaction.
A first-hand look at how store-and-forward could work in a clinic setting.
As compared to a real-time visit, Store-and-forward services provide access to data after it has been collected, and involve communication tools such as secure email.
That data can include X-rays, MRIs, photos, patient data, and even video-exam clips. Store-and-forward communications primarily take place among medical professionals to aid in diagnoses and medical consultations when live video or face-to-face contact is not necessary. Because these consultations do not require the specialist, the primary care provider and the patient to be available simultaneously, the need for coordinating schedules is removed, and the efficiency of the health care services is increased.
These technologies provide important benefits to patients and providers. Some of these benefits include:
- Patients can get timely specialty care without needing to travel beyond the location of their primary care providers.
- Wait times for specialty care are lessened, especially in areas with shortages of medical specialists.
- Primary care providers and medical specialists can review patient cases, regardless of their respective locations.
- Medical specialists can review patient cases when it is convenient for them.
- The Store-and-forward process can overcome language and cultural barriers.
Store-and-forward technologies are most commonly used in radiology, pathology, dermatology, and ophthalmology:
- In radiology, physicians at small rural hospitals can forward X-rays or MRI’s to specialists at major medical centers for review.
- In dermatology, primary care providers can take digital photos of their patients’ skin conditions and forward the images to dermatologists for review and determination of treatment if needed.
- In ophthalmology, eye screenings for diabetic retinopathy, a disease that is a major cause of blindness among individuals with diabetes, can be captured digitally by retinal cameras and transmitted to a specialist for review. These screenings are particularly effective in preventing vision loss or blindness.
Store-and-forward is also commonly used for electronic consultations (eConsults). eConsult is a web-based system that allows a primary care physician (PCP) and a specialist to securely share health information and discuss patient care. This physician-to-physician eConsult reduces the need for unnecessary specialty referrals as patient’s needs are resolved through the PCP.
It is important to note that store-and-forward services are not always reimbursable by private insurers, and Medicaid policies on this issue vary from state to state.
Remote Patient Monitoring
Personal health and medical data collection from an individual in one location, which is transmitted via electronic communication technologies to a provider in a different location for use in care and related support.
Learn more about telehealth and quality of care.
Monitoring programs can collect a wide range of health data from the point of care, such as vital signs, weight, blood pressure, blood sugar, blood oxygen levels, heart rate, and electrocardiograms. The data is then transmitted to health professionals in facilities such as monitoring centers in primary care settings, hospitals and intensive care units, skilled nursing facilities, and centralized off-site case management programs.
This type of service allows a provider to continue to track healthcare data for a patient once released to home or a care facility, reducing readmission rates. Monitoring programs can also help keep people healthy, allow older and disabled individuals to live at home longer and avoid having to move into skilled nursing facilities. RPM can also serve to reduce the number of hospitalizations, readmissions, and lengths of stay in hospitals—all of which help improve quality of life and contain costs.
It should be noted that Medicare provides reimbursem*nt for remote physiologic monitoring, which is similar to RPM, however is distinct to specific reimbursem*nt service codes and does not fall under the telehealth label in the Medicare program, but are instead remote communication technology-based services.
More detailed information on the benefits of RPM and care for the aging population can be obtained from: Center on Technology and Aging and The Oregon Center for Aging and Technology.
Mobile Health
Health care and public health practice and education supported by mobile communication devices such as cell phones, tablet computers, and PDAs. Applications can range from targeted text messages that promote healthy behavior to wide-scale alerts about disease outbreaks.
South Central Telehealth Resource Center’s video on mHealth exemplifies many of the most popular forms and uses of mHealth mobile applications.
This is a relatively new and rapidly evolving aspect of technology-enabled health care. mHealth often includes use of a dedicated application software (apps), which are downloaded onto devices.
Given its recent emergence into this field, policies governing the use of this technology are continually being shaped.
The Food and Drug Administration (FDA), the Federal Trade Commission (FTC), the Federal Communication Commission (FCC), and the Department of Health and Human Services (HHS) all have some jurisdiction oversight in this area. This factsheet from the National Consortium of Telehealth Resource Centers outlines some basic information regarding mHealth and FDA regulation.
