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Telemedicine 101: History and Evolution

March 4, 2019

The animated cartoon The Jetsons, set in a technologically advanced future, briefly showcases the youngest son Elroy video conferencing with his doctor.

That's right; in the 1960s, a TV show — known for its whimsical and elaborate inventions of what the future could look like — predicted the prevalence of telemedicine in consumers' lives.

What is telemedicine?

Modern technology has indeed facilitated the widespread deployment and adoption of telemedicine in health care practices of all sizes, but telemedicine isn’t necessarily a modern-day innovation.

JetsonPic2Image courtesy of Medical Monitor

Today’s discourse surrounding telemedicine involves effective reimbursement policies, legal parameters, the development of meaningful patient-provider relationships and leveraging trendy technology such as smart devices, artificial intelligence and blockchain in health care.

Let’s take a closer look at telemedicine, its evolution over the years, its pros and cons, and the benefits that telemedicine and telehealth in general offer to health care practices.

Telemedicine US Statistics

According to Advanced Data Systems Corporation’s comprehensive telemedicine description, here are several noteworthy telemedicine statistics:

  • More than 50 percent of hospitals in the U.S. maintain a telemedicine program

  • Telemedicine adoption rates are the highest in Alaska (75 percent), Arkansas (71 percent) and South Dakota (70 percent)

  • In 2015, approximately 800,000 telemedicine consultations were performed in the U.S.

  • In 2014, the value of the global telemedicine services market was estimated at $17.8 billion

  • The market is expected to grow at a rate of 18.4 percent each year through 2020

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Evolution of telemedicine

Telemedicine has existed in some form since the 1950s, telemedicine company Chiron Health explains in their brief history of telemedicine blog post. Universities and hospital systems leveraged the telephone to share records, consultations and even patient images from one location to another. (A rather cool telemedicine concept was envisioned in 1925. Inventor Hugo Gernsback illustrated the “teledactyl,” a robot that offered a doctor video game-like controllers to remotely evaluate and diagnose their remote patient.)

1925-Feb-science-and-invention-doctor-future-smAn illustration of the "teledactyl." Image courtesy of The

The goal was to connect with patients who resided in remote locations, delivering the same level of care as if that patient were in the same room as the medical professional. eVisit, creator of a telemedicine patient engagement platform, explained that in the 1960s, the US government funneled a lot of money into public health and defense departments to drive research and innovation in telemedicine.

While telemedicine still enables hospitals to deliver care to areas that are either remote or have scarce access to health care professionals and equipment, telemedicine has evolved to become more of a tool that offers convenience to even more patients.

This change has been spurred by developments in smart devices and personal medical devices. Patients are now empowered to track their own health on applications that live on their smartphones. Patients can even communicate with their primary doctors via HIPAA compliant messaging software, including texts and emails. Why should patients waste time in a waiting room when they can receive immediate care via video conference?

Examples of where telemedicine is used in health care

Examples of Telemedicine

  • Follow-up visits: Virtual follow-ups and check-ups can be used in place of in-person visits and even help prevent hospital readmissions. The likelihood of missed appointments and no-shows also decreases with telemedicine — it’s far easier to log onto a secure video call than to take time off from work for an in-person appointment.

  • Chronic disease management: Telemedicine software and mobile health (mHealth) software play vital roles in the effective management of chronic diseases. Chronic diseases already take a toll on patients; telemedicine is an easy and affordable way for patients to actively maintain control over their health and their relationship with their caregiver.

  • Assisted living visits:  Telemedicine offsets the need for in-person visits to assisted living facilities. Doctors and caregivers can remotely visit their patients at any time of day, and ultimately reduce unnecessary visits to the hospital.

Telemedicine vs. telehealth

Because telemedicine continues to evolve, the distinction between telemedicine and telehealth is becoming less and less defined. In fact, the American Telemedicine Association (ATA) treats “telemedicine” and “telehealth” as interchangeable terms. After all, both telemedicine and telehealth provide patients and providers with the ability to participate in patient monitoring and consultation, to access medical information and expertise and even to transmit medical images and reports.

However, some vendors and users do like to differentiate the two.

Telemedicine is a subset of telehealth, specifically the provision of clinical and medical services to patients through technology like video conferencing, text messaging, and audio. Telehealth is a broader concept than telemedicine, and can include services like patient monitoring via personal fitness tracking devices and non-clinical provider and administrative training.

Telemedicine vs. mHealth

There is also mHealth, which is shorthand for mobile health.

Without mHealth, telemedicine would be restricted to the Jetsons’ version of telemedicine: a video conferencing tool that provides virtual visits only.

mHealth takes advantage of the ubiquitous presence of cellphones and smart devices in consumers’ lives. Mobile health applications like Apple’s Health application and provider-supplied apps help the delivery of remote clinical care. Telemedicine has risen in popularity and usage because patients are taking advantage of the convenience factor. mHealth makes it possible for patients to take an active role in the self-management of their health.

Types of telemedicine

There are three main classifications of telemedicine solutions that health care practices can leverage: remote patient monitoring (RPM), store-and-forward, and real-time.

Types of Telemedicine

Remote patient monitoring (RPM)

Remote patient monitoring (RPM), also referred to as telemonitoring, allows providers to track and monitor their patients with chronic diseases (diabetes, hypertension, etc.). RPM solutions equip remote caregivers with vital patient data such as blood sugar or blood pressure levels so that they can review such data in nearly real time and get notified if a measurement is abnormal. RPM solutions makes it possible for chronically ill, at-risk or recovery patients to stay at home instead of being confined to a hospital or clinic.

RPM solutions simulate in-person communication, so they depend on health tracking tools that accurately track patient health and efficiently send health data to the relevant health care professionals. RPM solutions provide incredible value to health care providers; with them, the number of readmissions falls, the ability to practice effective preventive care skyrockets and the physician-patient relationship flourishes.

Examples of RPM telemedicine tools:

  • Glucose trackers

  • Wearable devices that track health and fitness levels

  • Smart beds that monitors patients’ health, communicate with hospital devices and equipment and automatically make necessary adjustments

  • Sensors that monitor the gait and balance of patients with walkers and canes

Store-and-forward/asynchronous telemedicine

Asynchronous telemedicine solutions, commonly referred to as store-and-forward telemedicine, enable providers to easily store and share patient medical data with other providers and practices. Asynchronous telemedicine solutions must therefore be secure, private and HIPAA compliant.

Asynchronous telemedicine solutions allow providers to experience the same kind of convenience that patients encounter with real-time telemedicine. Instead of relying on a bottlenecked process to share crucial patient data (during, for example, a referral), a primary doctor can leverage the technology to send an email with relevant information regarding a diagnosis for the ancillary care provider’s benefit.

Both clinical communication and patient outcomes are improved with asynchronous telemedicine. Patients, providers, technicians and physicians — all of these players can receive and access the same patient information, including lab results, X-rays or other clinical documentation, without needing to be in the same room at the same time.

Examples of store-and-forward telemedicine:

  • Teleradiology solutions that send patient X-rays to another radiologist

  • Teledermatology solutions that send patient photos for remote diagnosis

  • Telepsychiatry solutions that enable remote behavioral health treatment

Real-time telehealth

Synchronous telemedicine exists as well. It is also known as real-time telehealth and it facilitates real-time communication between physician and patient. Generally, real-time telehealth solutions take the form of audio and video communication and replace in-person visits. Real-time telehealth can either be conducted in the comfort of the patient’s home or at a nearby medical facility. Synchronous telemedicine requires video conferencing or audio telecommunication platforms that are HIPAA compliant.  

Notably, while synchronous telemedicine provides patients and physicians with an easy, convenient way to receive and provide medical treatment, health care providers have never intended it to fully replace in-person visits. Virtual telemedicine enables consultations, treatment recommendations and patient monitoring, but it’s intended to be an add-on service for people who have access to in-person medical treatment.

Examples of real-time telemedicine:

  • Live video and audio conferencing

  • Emergency virtual consultations

  • Remote follow-up visits

Health care specializations that can (and do) leverage telemedicine

Specialty medical practices benefit from telemedicine as well. A variety of specialists find value in the ability to provide consultations via video or audio. Some of these include:

  • Mental/behavioral health psychiatrists

  • Cardiologists

  • Dermatologists

  • Oncologists

  • Radiologists

  • Gastroenterologists

  • Pediatricians

Benefits of telemedicine

Patients undoubtedly benefit from telemedicine — just look at their expanded access to care via these solutions — but so do health care providers. Productivity, access to patient data and patient satisfaction can all be positively impacted when hospitals and clinics offer telemedicine. Additionally, the speed with which practices adopt telemedicine, and the success rates that those practices experience, has the ability to influence the rest of health care technology.

  • Productivity: Telemedicine speeds up appointment cycle times; a patient is no longer restricted to seeing a doctor or physician every six months or once a year. With telemedicine, patients can schedule consultations and follow-ups at times that work for them, which is helpful for both urgent and non-urgent medical matters. On the provider side, telemedicine is generally used with patients who can benefit from virtual consultations, basic monitoring and easy data sharing. When health care providers are able to divide their time and services based on case complexity, they can devote more time to those with more involved needs when necessary.  
  • Improved access: People with children or busy jobs, or those who are located in rural locations, benefit from telemedicine because they can receive and access clinical services outside of normal appointment hours. This means that medical staff can reduce overhead costs, provide after-hours appointments and minimize no-shows. Medical professionals can even expand their reach beyond their physical offices to provide care for at-risk patients living in remote locations.
  • Patient satisfaction: The convenience of telemedicine reduces appointment time by eliminating travel to medical practices and sitting in waiting rooms. Providers who use telemedicine want to provide the same level of service to their patients via virtual communication. Security and connectivity issues are at the forefront of telemedicine vendors’ concerns. Telemedicine also improves chronic disease management, solves issues of understaffing and optimizes follow ups.

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Limitations of telemedicine

It must be noted that telemedicine has some limitations. Some of those limitations exist for a reason since telemedicine doesn’t aim to replace in-person patient-provider relationships entirely. Telemedicine aims to supplement and optimize the delivery of care, taking into consideration the high cost of health care and the growing pervasiveness of chronic diseases.

One area of telehealth and telemedicine that has huge untapped potential is chronic disease management. Chronic disease management can benefit if practices move away from supplemental care delivery and toward a fully integrated care model. Instead of an irregular check-in, add-on service, chronic disease management telemedicine can revamp the entire idea of preventive health care.

While providers can increase their availability beyond normal business hours, that doesn’t mean that the primary physician will be the one providing that after-hours service. However, when that happens, providers must deal with fragmented patient data. Fragmentation of patient data happens when providers must piece together a patient’s history from different sources. This can lead to results like inappropriate prescriptions and incomplete, unnecessary or redundant care.

Security is a significant concern with telemedicine. (Just take a look at this list of the top 10 biggest healthcare data breaches.) Health care data breaches are especially concerning because of the integration of key identity data (Social Security numbers, birth dates and employment histories, for example) and patient health data. Potential identity theft possibilities aside, hospitals and health care practices that run on outdated equipment and software, or that haven’t updated to the newest set of industry standards and regulations, open themselves up to severe consequences like errors in reimbursement, operating losses, wrong drug dosages and even harm to patients.

Pros and cons of telemedicine

Sure, it’s good to take a look at the benefits a hospital or practice can receive from leveraging telemedicine technology, as well as the limitations they need to seriously consider. But you most likely want a quick run-down of the pros and cons of telemedicine, right?

Some of those pros and cons are:

Pros of telemedicine

  • Convenient, accessible patient care

  • Increased patient engagement

  • Optimized patient follow up and monitoring

  • Physician availability outside normal business hours

  • Better patient outcomes and reduction in readmissions

Cons of telemedicine

  • Specific telecommunications equipment required

  • Risk of reduced in-person visits

  • Unique legal and regulatory frameworks

  • Subjective reimbursement policies

  • Training required to bring health care providers up to speed

Pros and Cons of Telemedicine

Telehealth and telemedicine across all kinds of health care practices are natural evolutions of the medical industry thanks to technological advancements in telecommunications, mobile devices and online feedback. Health care is taking cues from other industries as the industry works double-time to keep up with ever-changing regulations and expectations in the delivery of care.

The technological innovations that impact and influence telemedicine correlate with changes in perspective in health care. Health care technological innovation help physicians and providers put patient satisfaction and engagement first, stress the importance of easy access to clinical services, and impress to vendors the benefit of affordable and easy-to-use health care software.

Which telemedicine solutions have you implemented in your health care practice?

G2 recently created the much-needed telemedicine software category; please leave a review regarding the benefits and hurdles your practice experienced when adopting a telemedicine tool.

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