II. Definitions
- Telemedicine
- Telecommunications (voice, video) to provide off-site health services to patients
- Synchronous Telemedicine
- Realtime virtual patient care
- Asynchronous Telemedicine
- Patient specific medical data recieved for later review and response
- Remote Monitoring
- Health data continuously collected from patient (Blood Pressures, Glucose monitoring)
III. Precautions
- Employ a HIPAA compliant mode of communication
- Use Test Patients first before using in practice
- Assess patient's appropriateness for Telemedicine
- Digital literacy
- Internet connection and compatible device (e.g. smartphone or computer)
- No significant language barriers (not a contraindication if Interpreters are available for visit)
- Adequate Vision and Hearing
- Patient or family willingness to send clinical data before visit (e.g. Glucose logs, diet log, Blood Pressures)
- Additional contact may be needed in between Telemedicine provider visits
- Phone calls
- Electronic messaging
- In person visits (new concerns, concerning findings on Telemedicine)
- Patients may lack the electronic and internet resources to allow for Telemedicine
- Telemedicine locations are being established in rural communities (e.g. VA partnerships with Walmart, American Legion)
IV. Technique
- Set expectations and goals for visit at the start of the encounter
- Maintain Bedside Manner while online
- Making eye contact with the patient requires the provider to look at the camera
- Maintain a pleasant speaking voice
- Clear verbal communication is key
- Social cues and body language are often hidden when communicating online
V. Protocol: Clinic Staff
- Ensure patient has necessary devices (facilitate DME prescriptions as needed)
- Electronic Device and connectivity
- Glucose monitoring (e.g. Continuous Glucose Monitoring)
- Blood Pressure Cuff
- Weight scale
- Employ the patient's home devices for Vital Signs
- Portable oximeter provides Heart Rate and Oxygen Saturation
- Smart watch provides Heart Rate (or teach a patient how to check their pulse)
- Weight scale
- Peak Flow meter
- TeleHealth setup and troubleshooting with office staff
- Obtain back-up phone numbers in case of technical difficulty
- Obtain consent for visit, billing and privacy discussion
- Gather previsit history and Review of Systems
- Inquire about new concerns
- Update medical record including medications, habits, recent hospitalizations and surgeries
- Remote Glucose monitoring (esp. Continuous Glucose Monitoring) is ideally performed between visits
- Review Glucose trends, time in range, average Glucose and low Blood Glucose
- Medication adjustments may be made between visits
- Cloud services include manufacturers (Dexcom, Clarity, Libreview) and platforms (Glooko, Tidepool)
- Obtain clinical data before the start of the visit
- Vital Signs (Blood Pressure, Heart Rate, weight)
- Blood Glucose readings
- Lab test results ordered at last visit
VI. Protocol: Clinical Encounter by Medical Provider
- Confirm that patient has appropriate environment for visit (privacy, safety) and reschedule as needed
- Patient not driving a vehicle or operating machinery
- Patient can devote full attention to visit (not speaking to others, no significant background noise)
- History
- Review together any previsit history, positive Review of Systems and new concerns
- Review Vital Signs
- Review clinical data
- Review lifestyle (diet and Exercise)
- Consider having patient demonstrate the food they eat, items in their refrigerator
- Patient might demonstrate their process for medication use (e.g. pill boxes, use of Insulin Pens)
- Telemedicine Focus Areas
- Avoid sensitive exams via Telemedicine (e.g. genitalia)
- Focused Telemedicine exams are available for many chief complaints
- Plan
- Adjust medications and lifestyle interventions
- Review lifestyle modifications
- Send patient an after visit summary
- Follow-up Visits
- Plan future labs before next visit
- Consider alternating in-person and Telemedicine visits for chronic medical problem management
- Arrange in-person visit for additional concerns, complications
VII. Evaluation: Musculoskeletal
- Upper Extremity Telemedicine
- Lower Extremity Telemedicine
VIII. Evaluation: Chronic Medical Care
IX. Imaging
- Decision rules may help guide who needs further evaluation with imaging
- Consider obtaining imaging followed by in person follow-up exam on same day
X. Management
XI. Resources
XII. References
- (2020) presc lett 27(5):27
- Yedlinsky (2021) Am Fam Physician 103(3):147-54 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Definition (NCI) | The use of telecommunications technology to provide, enhance, or expedite health care services, as by accessing off-site databases, linking clinics or physicians' offices to central hospitals, or transmitting x-rays or other diagnostic images for examination at another site. (Bartleby.com) |
| Definition (NCI_NCI-GLOSS) | The delivery of healthcare from a distance using electronic information and technology such as computers, cameras, videoconferencing, the Internet, satellite, and wireless communications. |
| Definition (MSH) | Delivery of health services via remote telecommunications. This includes interactive consultative and diagnostic services. |
| Definition (PSY) | Provision of health care via various forms of telecommunications media. |
| Definition (CSP) | delivery of health services via remote telecommunications; includes interactive consultative and diagnostic services. |
| Concepts | Health Care Activity (T058) |
| MSH | D017216 |
| Swedish | Telemedicin |
| English | TELEMED, telemedicine, telemedicine (treatment), Telehealth, Telemedicine |
| Czech | poskytování zdravotnických služeb prostřednictvím telekomunikací, telemedicína |
| Finnish | Telelääketiede |
| Russian | TELEMEDITSINA, ТЕЛЕМЕДИЦИНА |
| Japanese | 遠隔医療, テレメディシン |
| Croatian | TELEMEDICINA |
| Polish | Telemedycyna |
| Norwegian | Telemedisin |
| French | Médecine à distance, Télémédecine |
| Spanish | Telesalud, Telemedicina |
| Portuguese | Telessaúde, Telemedicina |
| German | Telemedizin |
| Italian | Telemedicina |
| Dutch | Telegeneeskunde |
