Telemedicine, the remote treatment of patients, is a broad concept that can’t be definitively demonstrated by a single app or piece of technology. It is a concept of care delivery that has many approaches. You’ve probably heard terms such as virtual visits, online appointments, and e-visits. Yes, these terms do refer to telemedicine, but they do so in the most general sense. They refer to replacing or augmenting a patient’s office visit with one that is done remotely. Let’s dig a little deeper into the types of telemedicine, as well as the uses, benefits, and drawbacks of each.
When we talk about telemedicine, it is easiest if we break it up into different modes. Not all telemedicine companies offer all modes of telemedicine, and not all physicians are comfortable using every type. Even more, not all modes of telemedicine are appropriate depending on the condition being treated. Telemedicine is not something that’s unknown. In today’s hyper-connected world, the fact is, you’re likely already using telemedicine without even realizing it.
The main modalities of telemedicine are:
- Store-and-forward telemedicine, also known as asynchronous
- Real-time, also known as live-interactive
- Remote Monitoring
In future articles, we will go into detail for each category. In this article, let’s do a brief intro on each to give the overall picture of today’s telemedicine.
Store-and-forward telemedicine is asynchronous. To help understand that, let’s use an analogy.
Everyone, hopefully, is familiar with email. It is an asynchronous communication technology. You send a message to someone. The recipient reviews the message some time later. While they’re reviewing your message, you could be sleeping or browsing your favorite social media site. Of course, you could also be incessantly clicking the refresh mailbox button. Whatever you’re doing, the point is that it’s up to you – you don’t need to always be there for the conversation to move forward. The recipient can spend as much time as they need on reviewing your message. Then, they carefully draft a response and send it back to you.
So, just like email, store-and-forward telemedicine does not require the physician and patient to be there at the same time. The patient (or referring physician) sends the necessary clinical information to the physician. The information is usually comprised of many of the same data a physician might gather in person: demographics, past medical history, history of present illness, allergies, medications, and the list goes on! Finally, at a later time, the physician reviews the information and sends a response.
Let’s give a real-life scenario. Suppose you wake up and notice a new rash on your leg that you can’t seem to stop scratching. You have an important early meeting with your boss at work and your doctor’s office is across town. So, you don’t have time to think, much less deal with this medical issue. So, despite your rash, you rush off to the office.
After your meeting, you have ten minutes to spare. Normally, you might not do anything about your rash and hope it goes away. Or, if your spouse has been expounding recently about the importance of taking care of your health, you might try and schedule a visit with your physician. However, you might not be surprised to learn that the next opening isn’t for several days, or worse, weeks! What a pain!!
But now you know there is a better option. In between meetings, you sneak off to the bathroom. Using store-and-forward telemedicine software that your physician’s friendly medical assistant told you about, you take several pictures of the rash on your leg. Next, you send the photos as well as accompanying details to your dermatologist.
Later that day, between patient appointments, your physician takes 2 minutes to review your details and sends a prescription for an anti-itch cream to your pharmacy. You pick up the prescription on your way home from work. You apply the cream as directed, and feel better within days.
Although store-and-forward telemedicine may sound new and exotic, you may in fact already be using it. Many practices have patient portals that patients can use to send messages to their physicians. Patients use these portals to send questions or request medications. That, by definition, is store-and-forward asynchronous telemedicine. And yes, physicians sometimes charge money for these interactions depending on your insurance and the level of service needed.
The next major telemedicine category is the real-time, interactive, or live telemedicine. It is the category that most people think of when telemedicine is mentioned. Just like the name implies, patient and physician interact in real-time, such as through a phone conversation or a Skype-like live video encounter. Such interactions can be scheduled ahead of time, or occur spontaneously if both parties happen to be available.
So, when you’re speaking to your physician over the phone, your conversation can be categorized as a real-time telemedicine visit. And yes, physicians can charge money for such interactions as well. The question of when and whether to charge the patient and if insurance covers these visits is an important challenge to be discussed in following articles.
The last telemedicine category is remote monitoring. This category largely deals with biosensors that can be used to monitor patient’s specific biological signs. Currently, remote monitoring is being used primarily for chronic diseases, home health, or specific medical conditions such as recovery from surgery.
Two representative examples of remote monitoring are glucose monitoring for diabetes and implantable devices for heart disease. Patients wear these devices every day, and regularly transmit the data to their physician. The data can be transmitted automatically from the devices or manually by the patient. For manual transmission, the patient simply logs the numbers and either sends them in electronically or brings in the paper log to their next physician visit.
Recently, there has been an explosion of new biosensing wearables available on the market. In addition to existing off-the-shelf pedometer, heart rate, and sleep monitors, there are now wearable respiration, brain activity, oxygen level, blood pressure, and many other monitor and sensor types.
At this point, many physicians do not recommend off-the-shelf wearables to their patients for capturing clinical information. The main reasons are that many wearables fail to provide medically significant, reliable, or sufficiently accurate data. Nevertheless, such devices are being rapidly adopted by patients to improve their general health and well-being. Fitbit, the maker of the popular movement and activity monitor, has seen tremendous demand and filed for IPO in May of 2015.
Mental health is another area that is rapidly adopting remote patient monitoring. Often, anomalies in patient’s physical movement patterns, and even shifts in patient’s mobile phone usage can act as a proxy for changes to their mental condition. With these methods, some suggest it is possible to signal early signs of depression and allow medical providers and family members to quickly respond with interventions.
Now that we introduced the major telemedicine categories, we should also mention that physicians might choose to combine multiple categories into a hybrid approach. For example, a patient could be monitoring their glucose and other biological signs, sending the physician reports using store-and-forward software, and occasionally talking to the physician in real-time over the phone. If you think that sounds complex, then you’re correct. Physicians definitively need their patients to have some basic knowledge and experience with telemedicine 2.0 before throwing curveballs like this.
The fact that telemedicine has several approaches, and the fact that clinics and technology vendors often refer to them in generic terms such as virtual visits, can (and does) cause confusion for patients.
For example, one of our customer’s patients was scheduled for a store-and-forward follow-up visit two weeks after their initial in-person appointment. Around the time of her follow-up, she contacted our helpline and asked what time the visit would be. Her impression was that a virtual visit must be a real-time video visit – she had no idea that a medical follow-up could be done asynchronously. Lucky for us, the patient was delighted to learn that there wasn’t a specific time of day for the appointment. So, when clinics are signing up their patients to use telemedicine, medical providers, staff, and software vendors must be careful to manage expectations and do their best to educate patients.
Gensler, Lauren. “Fitbit Files For IPO, Reveals Surprising Profits.” Forbes. Forbes Magazine, 7 May 2015. Web. 29 July 2015. http://www.forbes.com/sites/laurengensler/2015/05/07/fitbit-files-for-ipo/
Wang, Teresa. “The Future of Biosensing Wearables.” Rock Health, 09 June 2014. Web. 29 July 2015. http://rockhealth.com/2014/06/future-biosensing-wearables/
Last modified: 9/22/2015