Technology has brought a great revolution in the medical industry, and healthcare workers and providers are constantly looking for better ways to provide healthcare services to patients.

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Telemedicine is the current trending source of providing healthcare services to remote locations. Despite busy schedules, lack of accessibility, and low availability of healthcare, anyone can get high-quality healthcare services through the telemedicine platform. So,

What is telemedicine? And what are the countless benefits of telemedicine?

This article has a detailed introduction to telemedicine to understand its various aspects. Let’s dive in.
Contents: 1. What is Telemedicine? 2. What are the three types of telemedicine?
How Telemedicine can help people?
How to implement telemedicine in your healthcare organization
Problems with telemedicine

How telemedicine is used by healthcare professionals
How telemedicine helps patients

The Takeaway

1. What is Telemedicine?
Over the past three decades, researchers, clinicians, and health experts have laid a great emphasis on the integration of telecommunications and advancing technology for the betterment of healthcare facilities. Telemedicine is a successful innovation of the modern era by using information technology.

Introduction to telemedicine

Telemedicine is an umbrella term encompassing many technologies and applications currently being used to promote public research and the advancement of medical services and facilities. Telemedicine’s definition often gets confused with telehealth as both the terms are often used interchangeably, but telemedicine is different from telehealth.

Telemedicine definition and background

Telemedicine can be defined as communication and information technologies to provide standard health care to distant participants.

However, this term is not new; the background of telemedicine comes from the early 20th century. Around the 1960s, telephones were being used by healthcare professionals to guide and give health advice to patients.

With the advancement of telecommunications, telemedicine also adapted new technologies, devices, and methods. Telemedicine is sometimes also referred to as ‘digital practice’ in the current era. Today the spectrum of telemedicine is vast, including video conferencing, audio calls, and various other data transmission technologies.

There has been a rapid hike in the telemedicine stocks price in recent years. The Covid-19 pandemic has propagated telemedicine to new heights. As a result, a large population of the United States is shifting to virtual telemedicine services replacing health care visits.

What are the telemedicine regulations by the state?

The United States of America does not provide a standardized license that could work for the health professionals throughout the country hence why each state has its regulations and licensure processes for telemedicine. Therefore, a physician can only get a permit for practice issued for that particular state.

Telemedicine regulations by the state were established back in 2014 when the Federation of State Medical Boards passed the Interstate Medical Licensure Compact to help facilitate medical practitioners with their interstate practice. A physician can apply for a medical license to practice telemedicine in their home state for practicing in another state. The verification from the home state is a big go-ahead.

However, the telemedicine regulation by the state has been significantly eased in the CoronaVirus pandemic. Currently, many conditions permit emergency licenses to physicians licensed in other states who may assist with this health emergency.

Are telemedicine and e-health similar?

E-health is an umbrella term representing the entire health industry and is considered equivalent to e-commerce involving telematics and medical informatics, whereas telemedicine is just a market niche. E-health is broader and more directed towards the business side, while telemedicine provides healthcare facilities to distant participants. Telemedicine and e-health are sometimes used interchangeably, but both terms represent different meanings and goals.

2. What are the three types of telemedicine?
The introduction of telemedicine in the health industry has positively influenced healthcare quality, reliability, and availability for people living in distant locations. In general, telemedicine is categorized into three types further associated with sub-types.

The three main types of telemedicine are as follows,

Store-and-forward: In this type of telemedicine, the patient does not have to meet the practitioner; instead, all the medical documents such as medical reports, images, lab data can be transferred to the specialist.
Remote monitoring: Other names for remote monitoring are ‘self-monitoring’ and ‘ self-testing. In this type of telemedicine, different technological devices are used to monitor the patient’s health status and clinical signs.
Real-time interactive service: This type of telemedicine is an interactive service that provides immediate advice and medical attention to patients.
There are many subtypes of real-time interactive services, such as; telenursing, telepharmacy, and telerehabilitation.

Telenursing refers to the promotion of nursing services through telecommunication technology.

Telepharmacy gives patients pharmaceutical advice through digital channels such as online appointments through websites, live chats, and apps when getting in contact with pharmacists is impossible. Similarly, telerehabilitation refers to providing rehabilitation consultation and advice through online communication channels.

The introduction of telemedicine to the health industry has turned out to be a successful step in enhancing the accessibility of healthcare services to people who have a limited approach to direct healthcare visits and facilities.

3. How Telemedicine can help people?

The idea of telemedicine is to overcome the barriers associated with healthcare delivery and develop equity and welfare for everyone to receive necessary healthcare resources and intervention.

The background of telemedicine and the current data suggests that telemedicine has been convenient both from the patient and health profes’[sional’s aspect,

a)How telemedicine is used by healthcare professionals

Healthcare professionals are using telemedicine for various clinical and non-clinical purposes.

Clinical uses of telemedicine by healthcare professionals

The clinical uses of telemedicine by healthcare professionals are as follows;

The professionals extensively use telemedicine for the evaluation, urgent care, and management of patients who might need transfers, decisions, and quick responses.
Healthcare professionals who cannot reach their patients use telemedicine for supervision and providing primary care and can also give prescriptions. For example, mental health experts can prescribe ADHD telemedicine Adderall to people dealing with ADHD through online consultations.
Health care professionals are actively using telemedicine to promote good health and wellness. For example, people struggling with obesity can contact a telemedicine doctor for a phentermine prescription or advice.
Professionals use telemedicine to track the provisions of treatment, symptoms, and progress of their patients over time.
Healthcare professionals widely conduct the follow-up care and supervision of patients with chronic health ailments and their regular status tracking.
Telemedicine appointment is very easily delivered to the patients hence why healthcare professionals can carry their sessions with their patients more frequently and stay updated with their progress.
Telemedicine urgent care for patients with immediate care or emergency care is being used by professionals and specialists who are not available at the moment.
Telemedicine is not just limited to treating humans; vet telemedicine has also advanced in the past year, offering many healthcare services to pets.

Non-Clinical uses of telemedicine by healthcare professionals

The non-clinical uses of telemedicine by healthcare professionals are as follows:

Telemedicine is a significant source of education for distant patients and is considered one of the most excellent tools for patient education.
Nowadays, health professionals use telemedicine to supervise, research, and expand healthcare networks.
Telemedicine is an intelligent way to manage patient databases, records, listings, and overall monetizing of the healthcare system.

Telemedicine benefits are far beyond the efficiency and convenience of professionals. In actuality, telemedicine benefits are fully enjoyed by the patients;

b) How telemedicine helps patients

The telemedicine benefits for patients are as follows;

Telemedicine has made healthcare possible for patients in remote locations.
Patients find telemedicine very accessible and more effortless than clinical visits without facing the struggles of the time, traveling, and long waiting room hours.
Patients that are either bedridden or disabled and traveling to their therapist becomes tantalizing. Telemedicine is the perfect solution for patients who have mobility restrictions or are ill to travel.
Telemedicine increases the autonomy of self-management and online self-monitoring.
Scheduling therapy online via telemedicine is extremely convenient. Patients can schedule their online sessions according to their ease.
Telemedicine gives every resident an equal opportunity to utilize public resources despite societal, financial, and mobility barriers.
Patients do not have to rely entirely on the medical system. Instead, telemedicine benefits for patients help secure privacy and self-esteem for patients who are less confident in getting into the process of medical check-ups, especially for patients with mental health issues.
Digital connection of patients with their therapists through telemedicine has shown increased encouragement in patients to get help for their mental health issues from their homes.
Post-surgical patients and those requiring rehabilitation have better health outcomes while receiving their treatment plan at home via telemedicine. The home environment seems to positively impact the patient’s minds compared to the hospital environment.

Online doctor visits and telecommunication for health care services are becoming more and more popular for many other reasons. Telemedicine benefits are not just limited to accessibility and ease. The most critical question regarding telemedicine is;

Is telemedicine covered by insurance?

Health systems often require tweaking, fine-tuning, and even reconstruction.

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GENERAL
Healthcare legislation in countries in transition, emerging economies, and developing countries should permit – and use economic incentives to encourage – a structural reform of the sector, including its partial privatization.

KEY ISSUES

· Universal healthcare vs. selective provision, coverage, and delivery (for instance, means-tested, or demographically-adjusted)

· Health Insurance Fund: Internal, streamlined market vs. external market competition

· Centralized system – or devolved? The role of local government in healthcare.

· Ministry of Health: Stewardship or Micromanagement?

· Customer (Patient) as Stakeholder

· Imbalances: overstaffing (MDs), understaffing (nurses), geographical distribution (rural vs. urban), service type (overuse of secondary and tertiary healthcare vs. primary healthcare)

AIMS

· To amend existing laws and introduce new legislation to allow for changes to take place.

· To effect a transition from individualized medicine to population medicine, with an emphasis on the overall welfare and needs of the community

Hopefully, the new legal environment will:

· Foster entrepreneurship;

· Alter patterns of purchasing, provision, and contracting;

· Introduce constructive competition into the marketplace;

· Prevent market failures;

· Transform healthcare from an under-financed and under-invested public good into a thriving sector with (more) satisfied customers and (more) profitable providers.

· Transition to Patient-centred care: respect for patients’ values, preferences, and expressed needs in regard to coordination and integration of care, information, communication and education, physical comfort, emotional support and alleviation of fear and anxiety, involvement of family and friends, transition and continuity.

The Law and regulatory framework should explicitly allow for the following:

I. PURCHASING and PURCHASERS

(I1) Private health insurance plans (Germany, CzechRepublic, Netherlands), including franchises of overseas insurance plans, subject to rigorous procedures of inspection and to satisfying financial and governance requirements. Insured/beneficiaries will have the right to apply contributions to chosen purchaser and to switch insurers annually.

Private healthcare plans can be established by large firms; guilds (chambers of commerce and other professional or sectoral associations); and regions (see the subchapter on devolution under VI. Stewardship).

Private insurers: must provide universal coverage; offer similar care packages; apply the same rate of premium, unrelated to the risk of the subscriber; cannot turn applicants down; must adhere to national-level rules about packages and co-payments; compete on equality and efficiency standards.

(I11) Breakup of statutory Health Insurance Fund to 2-3 competing insurance plans (possibly on a regional basis, as is the case in France) on equal footing with private entrants.

Regional funds will be responsible for purchasing health services (including from hospitals) and making payments to providers. They will be not-for-profit organizations with their own boards and managerial autonomy.

(I12) Board of directors and supervisory boards of health insurance funds to include:

– Two non-executive, lay (not from the medical professions and not politicians) members of the public. These will represent the patients and will be elected by a Council of the Insured, (as is the practice in the Netherlands)

– Municipal representatives;

– Representatives of stakeholders (doctors, nurses, employees of the funds, etc.).

(I13) The funds will be granted autonomy regarding matters of human resources (personnel hiring and firing); budgeting; financial incentives (bonuses and penalties); and contracting.

The funds will be bound by rules of public disclosure about what services were purchased from which providers and at what cost.

Citizen juries and citizen panels will be used to assist with rationing and priority-setting decisions (United Kingdom).

(I2) Procurement of medicines to be done by an autonomous central purchasing agency, supervised by a public committee (drug regulatory authority) aided by outside auditors.

All procurement of drugs and medications will be done via international tenders.

The agency will submit its reimbursement rates for drugs on the PLD to external audit in order to accurately reflect pharmacists’ overhead costs. At the same time, the profit margins on all drugs, whether on the PLD or not, will be regulated.

This agency should be separate from the Health Insurance Fund and the Ministry of Health. This agency will also maintain national drug registries. It will secure volume discounts for bulk purchasing and transparent, arm’s-length pricing.

(I21) Use of reference prices for medicines. If the actual price exceeds the reference price, the price difference has to be met by the patient.

(I3) The Approved (Positive) List of Medicines will be recomposed to include generic drugs whenever possible and to exclude expensive brands where generics exist. This should be a requirement in the law. Separately, an Essential Drug List will be drawn up.

(I31) Encourage rational drug prescribing by instituting a mixture of GP and PHC incentives and penalties, or a fundholding system: budgets will be allocated to each GP for the purchase of drugs and medications. If the GP exceeds his/her budget, s/he is penalized. The GP gets to keep a percentage of budget savings. Prescription decisions will be medically reviewed to avoid under-provision.

(I4) Payments and Contracting

Payment to providers should combine, in a mixed formula:

BLOCK CONTRACTS

Capitation – A fixed fee for a list of services to be provided to a single patient in a given period, payable even if the services were not consumed, adjusted for the patients’ demographic data and reimbursement for fee-for-service items.

Inflation-adjusted Global budgeting (hospitals) and block (lump sum) grants (municipalities)

COST and VOLUME CONTRACTS

Provide incentives and reward marketing efforts which result in an increase in
demand/referral beyond the limit set in a block contract.

COST PER CASE CONTRACTS

Apply Diagnosis Related Group (DRG)/ Resource-based Relative Value (RBRV) / Patient Management Categories (PMCs) / Disease Staging/Clinical Pathways

Levels of reimbursement, case-mix adjusted to be decided by external auditors.

Contracts with providers should include:

· Waiting Times Guarantee

· Single Contact Person(“Case Officer”) for the duration of a stay at the hospital

· Hospital benchmarking (individual-level data on costs, diagnoses, and procedures during entire case episodes: inpatient admissions and outpatient visits; cost-effectiveness of services.

· Performance targets in performance agreements with all healthcare facilities, both public and private.

· All payments – wages included – will be tied to these targets and their attainment as well as to healthcare quality as determined by objective measures (internal, external, and functional benchmarking), clinical audits (sampling), as well as customer satisfaction surveys and interviews and discussions with patients.

· Provider and Staff Bonuses and penalties tied to exceeding/under-performing targets and contract variance

· Patients’ rights, including their rights to litigate

Selective contracting will be allowed on all levels (including specialist ambulatory care and hospitals), although all providers, private and public, will be permitted to apply for contracts with health funds and insurers. The funds will choose from among private providers either following a process of deliberation, or via an auction, or public tender (United Kingdom).

(I5) Commissioning preference will be given to the purchase of Primary Healthcare over secondary, or tertiary Healthcare.

II. PROVIDERS

The Law and regulatory framework should explicitly allow for the following:

(II1) Hospital Management

(See separate document)

The law should allow:

I. Co-location of a private wing within or beside a public hospital

II. Outsourcing of non-clinical support services

III. Outsourcing of clinical support services

IV. Outsourcing of specialized clinical services

V. Private management of public hospitals

VI. Private financing, construction, and leaseback of new public hospitals

VII. Private financing, construction, and operation of new public hospitals

VIII. Sale of public hospitals as going concerns

IX. Sale of public hospitals for alternative use

X. Consolidation of redundant public healthcare facilities by merging them or closing down some of them

XI. Privatization of Primary Healthcare (PHC) clinics within medical centers

XII. Healthcare institutions will be granted autonomy regarding matters of human resources (personnel hiring and firing); administering financial incentives or penalties, budgeting; and contracting.

XIII. Privatization pharmacies inside medical centers and hospitals.

(II2) Primary, Ambulatory, and Secondary Care and General Practitioners (GP)

(II21) Limit the number of patients per GP

(II22) Stimulate and financially incentivize the following activities, which should be declared national priorities within a National Needs Assessment:

· Group practices and networks (for continued, around-the-clock services)

· Day and minimally invasive surgery

· Dispensaries

· Home and day care services

· Long-term care (nursing homes, visiting nurses, home I.V. and other services provided to chronically ill or disabled persons)

· Patient hotels

· Rehabilitation facilities and programs

· Provision of merit goods (also through mass campaigns)

· Conversion of hospital units to outpatient services,and day-care centers

Example of such financial incentives:

· Physicians will be entitled to see patients who receive services free-of-cost
in the public sector in the morning, and private patients who pay the full
cost of the medical consultation in the afternoon.

· Allow private beds in public hospitals and private financing of hospital stays (NHS, UK)

· Subsidize or fully cover transaction costs (legal fees of contracting, compliance, accounting, etc.)

(II23) Allow hospitals to administer packages of outpatient services and be reimbursed by the Health Insurance Fund (or funds).

(II24) Impose an admission quota on medical schools; reduce the obligatory number of doctors per 1000 population; and make GP a medical specialty.

(II25) Strengthen the gatekeeper function of GPs and healthcare provision in outpatient settings.

Encourage gatekeeping by instituting a mixture of GP and PHC incentives and penalties, or a fundholding system (United Kingdom, Estonia, Spain):

Budgets will be allocated to each GP for the purchase of secondary and tertiary healthcare (as well as to cover salaries, premises, diagnostic tests). If the GP exceeds his/her budget, s/he is penalized. The GP gets to keep a percentage of budget savings.

Referrals will be medically reviewed to avoid under-provision.

(II26) Introduce GP target income and adjust services and fees to reach it (perhaps by using tax credits).

(II27) Provide GPs and other types of primary and secondary healthcare providers with financial incentives to relocate to remote and rural areas

(II28) Render clinical and best practice guidelines mandatory (not merely recommended)

(II29) Encourage managed care (peer review panels, pre-approval procedures for surgery, case management for the chronically ill, formularies limiting pharmacy reimbursement to an approved list, and other contractual provisions).

III. PRIVATE SECTOR

Risks of privatization and private non-managed, imperfect competition: market failure, as patients received too many unnecessary services, due to fee-for-service reimbursement and information asymmetry.

The Law and regulatory framework should explicitly allow for the following:

(III0) Allow private primary healthcare physicians to offer preventive care, treatments and interventions after office hours, emergency dental and medical care, emergency home treatment, preventive checkups for preschool and school children, patronage and polyvalent patronage services, and all other elements of comprehensive healthcare.

(III1) Arrangements with the private sector and Private-Public Partnerships (PPP) for the provision of healthcare:

(III11) Service Contract (Dominican Republic), or Contracting-out

The government pays private entities – including doctors – to perform specific healthcare tasks, or to provide specific healthcare services under a contract. The private service providers can make use of state-owned facilities, if they wish, or operate from their own premises.

Payments by the government are usually based on capitation (a fixed fee for a list of services to be provided to a single patient in a given period, payable even if the services were not consumed) adjusted for the patients’ demographic data and reimbursement for fee-for-service items.

(III12) Management Contract Outsourcing (Cambodia)

The government pays private entities to manage and operate public health care facilities, like clinics, or hospitals.

(III13) Lease (Romania since 1994)

Private entities – including doctors – pay the government a lump sum or monthly fees to use specific state-owned equipment, state-employed manpower, clinics, or complete public health care facilities.

The private entity is entitled to all revenues from its operations but also bears all commercial risks, is responsible for management and operations and liable for malpractice and accidents.

The state is still responsible to make capital investments in the leased facility or equipment, but maintenance costs are borne by the private entity.

(III14) Concession and Build-Operate-Transfer (BOT) (Costa Rica)

Concession is exactly like a lease arrangement (see above) with one exception: the private entity is responsible for capital investment. In return, the contract period is extended and can be voided only with a considerable pre-advice.

In BOT (Build-Operate-Transfer) and ROT (Rehabilitate-Operate-Transfer) the capital investment involves the construction or renovation/upgrade of new healthcare facilities. The private entity uses the constructed facility to provide services. After a prescribed period of time has elapsed, ownership is transferred to the government.

(III15) Divestiture and Build-Own-Operate (BOO) (Texas, USA)

The law should permit the outright sale of state- owned health care facilities to a qualified private entity, including physician groups who band together to purchase previously state-run facilities.

Another possibility is a BOO scheme, in which the private entity contractually undertakes to add facilities, improve services, purchase equipment, or all three.

(III16) Free entry

The law should allow qualified private providers to operate freely. Though regulated, these private firms will have no other relationship with the state.

Such entities would have to be licensed, certified, overseen, and accredited for expertise, safety, hygiene, maintenance, track record, liability insurance, and so on.

The state may choose to encourage such providers to locate in specific regions, to cater to poor clients, or to provide specific healthcare tasks or services by offering tax incentives, free training, access to public facilities, etc.

(III17) Franchising (Kenya, Pakistan, Philippines)

A private firm (franchisee) acquires a license from and shares profits with the franchisor (a domestic, or, more often, foreign firm). The franchisee uses the brand name, trademarks, marketing materials, management techniques, designs, media access, access to approved suppliers at bulk (discounted) prices, and training offered by the franchisor. The franchisor monitors the performance and quality of service of the franchisee.

This model works mainly in preventive care, family planning, and reproductive health.

The World Bank (“Public Policy for the Private Sector”, Note number 263, dated June 2003):

“Franchisers in the health sector, often supported by international donors and nongovernmental organizations (NGOs), establish protocols, provide training for health workers, certify those who qualify, monitor the performance of franchisees, and provide bulk procurement and brand marketing.”

(III18)Allow Charities and Not-for-profit organizations to run health insurance funds and a variety of providers (including full-scale secondary and tertiary healthcare institutions).

(III9) Voluntary Health Insurance (substitutive; complementary; and complementary), subject to open enrollment periods and mandatory coverage of dependants (to prevent cream-skimming and adverse selection).

IV. FINANCING