Over the last several years, medicine has undergone some major transformations. One of the most significant has been the growth of alternative delivery methods of health services with the use of ever-evolving technology.
Telehealth and telemedicine have radically changed the way that patients receive healthcare. Because providers no longer need to be in the same room with patients, location is no longer a barrier to high-quality treatment. With many services able to be provided without real-time meetings, schedules have also become less limiting. Costs are reduced while access is increased, addressing two of the major issues that can keep patients from receiving the care that they need.
Telehealth and telemedicine are sometimes used interchangeably, but they actually have distinct characteristics that distinguish them from each other. Though they both contribute to the overall care of patients, they do so from different standpoints: clinical and nonclinical. When it comes to telehealth vs telemedicine, there are many benefits and ways to implement both.
The term telemedicine is used to describe clinical healthcare services provided through the use of telecommunications technology that treat or help care for patients. An example of this could be having an appointment over video call with your speech-language pathologist or a dietician creating a specialized plan for you based on an information sheet you filled out about your eating habits and health.
There are three common forms of telemedicine: asynchronous, synchronous and remote monitoring. They may be used separately or in conjunction with one another as part of a broader treatment plan.
Synchronous telemedicine occurs when providers and patients meet at the same time over video or audio conference to have a face-to-face meeting, just as they would in the typical clinical setting, to check in, discuss issues, perform examinations and create health care plans. It’s sometimes referred to as real-time telemedicine and is a wonderful option for those who need to be able to be seen by a doctor but are unable to attend an in-person appointment.
For synchronous telemedicine appointments, patients will have a very similar experience to what they would when going into a doctor’s office or other clinical settings to meet with their doctor. The appointment might be scheduled online or over the phone. Details that might be otherwise gathered in the waiting room of a doctor’s office might be input online by the patient ahead of the appointment or a member of the patient’s care team. For example, a physician’s assistant or nurse might gather details over the phone or video conference ahead of the conference with the doctor.
When you get on the phone call with your doctor, the appointment will begin just like one in a traditional setting would. You might say your greetings and the doctor will likely ask if there have been any changes in your health since your last appointment. If you take any prescriptions regularly, your doctor will probably ask how the medicine is working for you, if you think there are indications that your dosage might need adjusting and if you are in need of any refills. Your doctor also might ask for your most recent blood glucose numbers if you are diabetic.
Although your care team cannot be there to collect your vital signs, you may be able to complete some of these on your own for your doctor to record. If you have a blood pressure cuff, your doctor might want you to take your blood pressure. Likewise, you may be asked to take your temperature if you have a thermometer available. If you have a wearable device, you may be able to provide additional information that it collects for you, such as your heart rate, or your provider may show you how to take your pulse using the arteries in your wrist or neck.
Once you’ve completed these initial interactions, you’ll get to the meat of the appointment. If you’re experiencing an issue and have set up the appointment to address it, now will be your time to share what is going on.
Otherwise, your doctor might proceed to a physical examination. Though you are not in the same space, providers are still able to gather a lot of valuable information via video conference.
They’ll likely begin by asking you to sit up straight and visually evaluating your appearance in terms of health. Doctors can gauge a lot from things, like if your skin looks sallow, if your eyes are bloodshot or have dark circles and the state of your mouth. They can also glean information from things like the coherence of your speech and your general demeanor when interacting.
You may be asked to demonstrate your ability to turn your head from side to side and down and up, and your doctor may want to see any areas of the body that are exposed, such as your arms and hands. He or she might ask if any parts of your body seem swollen or are experiencing tenderness and have you press in different places on the body to assess these.
If you’re experiencing pain or another issue in a specific place, your doctor may ask you to direct your camera to that area to get a visual of it. Numbness can be a sign of a more serious issue, so if an extremity is experiencing numbness or tingling, your doctor may ask you to point your camera to the limb and perform small movements to evaluate the situation.
Your provider may request additional actions for you to take depending on the circumstances of the telemedicine appointment. Though some of these may seem silly, they are important parts of building a full picture of your health through video conferences. By following the doctor’s instructions, you are allowing your care team to provide the best care for you through this exciting new medium.
Asynchronous telemedicine encompasses clinical services that occur on separate timelines, meaning that providers and patients never have to meet together at the same time. This is sometimes referred to as store-and-forward telemedicine and is especially useful for those whose schedules don’t allow them to have traditional interactions with their care teams.
Many aspects of asynchronous telemedicine are also present in traditional medical settings, so patients may be used to them already. Things like sending forms to a patient to fill out ahead of time or reminders of upcoming appointments are examples of the asynchronous ways that medicine can work.
Asynchronous telemedicine takes these and modernizes and expands upon them. Because telecommunications technologies have vastly improved over the past few decades, there are now many ways that patients may interact with and receive treatment from their care team using telemedicine without necessitating a scheduled appointment. Faxing, email, messenger and AI all allow for more comprehensive treatment delivered in ways that are most efficient for the task at hand.
The design of asynchronous telemedicine means that information must be delivered from the patient to the provider and vice versa using telecommunications. Many times a patient will initiate the telemedicine services by completing a questionnaire the provider has designed to gather initial information about potential patients. Once a patient has completed this and submitted it to the provider, the care team can then initiate the next steps of the process.
Doctors will likely need more information from patients after they’ve reviewed the first submission. Patients may be asked to answer further questions to fill in details or provide picture or video data that doctors can then review and use to inform a treatment plan.
Asynchronous care is often used in cases where a specialist is needed, and patients can benefit greatly. In traditional settings, it often takes months to get into a specialist’s office for an evaluation. While waiting for the appointment, conditions can worsen, and patients might incur extra costs trying to manage the issues over an extended period of time.
Through asynchronous telemedicine, that wait time can be greatly reduced. Instead of having to schedule and wait for an in-person appointment, patients may have their information and accompanying evidence forwarded to a specialist who can then assess the patient’s condition. Once specialists have examined the patient’s status, they can send their assessment back to the primary care physician to share with the patient and use to craft a care plan.
When patients have to be outside of the direct care of their providers but still need to be medically monitored, remote monitoring may be ideal.
In one common remote monitoring situation, patients or their in-home caregivers are given tools to monitor the health of the patient away from a clinical setting. Which tools are used can vary based on the patient’s diagnosis and condition, but typical examples are blood pressure equipment, thermometers and scales. The tools also include a way of transferring the data to the patient’s doctor or care team, such as a tablet.
The patient or the patient’s caregiver will use these tools throughout the day to measure the patient’s condition. Once the data is collected, they will enter it into the tablet or other provided technology. The patient’s care team will receive this data and use it to make decisions about the patient’s treatment. Additionally, members of the care team may reach out through the tablets or via phone to ask questions about any symptoms the patient is experiencing.
Another type of remote patient monitoring occurs when patients are set up with devices that can directly communicate to the care team. In these cases, patients may be sent home with monitoring devices that they can wear continuously or during certain activities. Commonly called wearables, these include devices like FitBits and Apple Watches that can measure different patient vitals such as heart rate and sleep patterns. The devices will then share the data gathered with the patient’s care team, who can use it to make decisions regarding patient health.
Although telehealth also uses technology and electronic telecommunications to facilitate remote health care services, the term refers to a broader range of services. While telemedicine describes clinical services, telehealth includes nonclinical services. Nonclinical services are those that support patient health but do not involve diagnoses, treatment or direct care for patients.
There are many moving parts that go into providing healthcare for patients, many of which fall under the nonclinical umbrella. Consider these scenarios to help grasp the scope of all of the nonclinical individuals that might play a part in your telehealth experience.
A hospital executive has made sure to find high-quality candidates who are well-educated and have the tools to succeed in their positions with the help of a medical recruiter. The human resources administrator has interviewed and trained those candidates in hospital protocols. An IT administrator has made sure that the hospital’s network is running efficiently and that medical professionals are able to perform all of the activities necessary for telecommunications between them and their patients.
A receptionist might call you to schedule your appointment with your provider. Medical transcriptionists might listen to the video conference between you and your provider to record information that the doctor can then look back on when developing your health plan. An administrative assistant might collect details from you before your video call to give you more direct time with the doctor. A medical biller and coder can then read the list of services you received and compile bills for your insurance provider.
Your doctor may have assigned you a medical device over your video conference. This was designed by a biomedical engineer with the help of biomedical technicians. You might have been prescribed a new medication that your doctor became familiar with through the use of samples provided by a pharmaceutical representative.
All these roles play an important part in creating quality telehealth services.
Telemedicine and Telehealth Are Here To Stay
Though telemedicine and telehealth are relatively new to medicine, in the short time they’ve been on the scene they’ve had a powerful impact on the way patients receive healthcare by improving access and limiting expenses.