When the COVID-19 pandemic hit the United States in early 2020, telemedicine took a huge leap forward. Due to the pandemic and under the direction of federal, state and local authorities, the necessary relaxation of the supervisory and insurance rules for providers of advance practice (APP) redefined access to care through telemedicine and gave providers and health systems a new understanding of the potential of Telemedicine meeting the needs of their patients.1,2
The decision to reduce physicians’ supervisory duties for medical assistants (PA) and nurses (NP) allowed all health care providers to work at the top of their license, training and experience. Adjustments to insurance reimbursement allowed providers to bill for telemedicine encounters at the same rate as in-office visits. The benefits of telemedicine were evident. However, obstacles remain to the full implementation and continuation of telemedicine.
The basics
Understand telemedicine terminology
Understanding telemedicine terminology improves the dialogue between providers. Telemedical terms are listed below (Table 1) .3-8 Although some people use the terms interchangeably, this adds to confusion.
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Table 1. Telemedicine Terminology 3-8
| Telehealth | A collection of resources or methods used to improve health care, public health, and the provision and support of health education using telecommunications technologies |
| Telemedicine | Providing professional services to a patient over an interactive telecommunications system at a remote location provider |
| Asynchronous | 2 or more activities do not take place at the same time |
| Synchronous | 2 activities at the same time: for example a personal visit to telemedicine |
| Remote monitoring of the patient | The patient uses devices to transmit data to the provider |
| E-health | Electronic process and communication (email and patient portals) |
| Virtual e-visits or virtual medicine / care | Face-to-face telemedicine visits |
| Virtual reality | Virtual advanced procedures; interactive virtual reality simulator |
| Expanded reality | Simulated teaching aids; spherical recordings (or 360º recordings) |
| Facilitated care | Healthcare professionals, with the patient ensuring standard of care, are present to provide blood pressure measurements or other necessary information |
| Not facilitated care | Directly to the consumer without the need for other healthcare providers during the on-site visit |
Waller and Stotler5 described 3 areas of telemedicine: Functionality, application, and technology. Functionality describes the use of telemedicine. An example of the functionality of telemedicine is a consultation between two patient care providers or a specialist who interprets a case remotely. Providers can use this technology to monitor remote devices (such as an electrocardiogram or glucose monitor), with patients sending the information to their providers. With telemedicine, specialists can look after, monitor and advise other providers in real time.
Telemedicine Applications differ according to specialty, disease process and treatment method. Telepsychiatry is an example of a specialty in telemedicine, while teleasthma is an example of telemedicine for treating a disease process. Rehabilitation and physiotherapy are an application as part of the treatment modalities.
Outdated or inferior technology can be a limiting factor in the use of telemedicine. The full potential of telemedicine is only possible if there is sufficient connectivity and network support
Telemedicine and access to care
Initially, the appeal of telemedicine was its ability to provide high quality health care to medically underserved areas. Even before the pandemic, the variety of telemedicine modalities had expanded to include surveillance, educational opportunities and training. The introduction of virtual reality to telehealth has expanded practical applications and created three-dimensional possibilities for procedures.7,8 The need to provide medical care to medically underserved areas is an ongoing problem, especially given the dearth of health care providers in various parts of the USA. With recent improvements in digital infrastructure, telemedicine is beginning to address this need.
This article originally appeared on Clinical Advisor
