How many times have you heard it said that the internet has transformed modern life? Indeed it's probably changed how you stay in touch with family and friends, purchase goods and services, and even search for information about health problems.
A variety of telehealth tools are available to help you manage your health care and receive the services you need. Are you taking advantage of them?
Telehealth is the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely and manage your health care. These may be technologies you use from home or that your doctor uses to improve or support health care services.
Consider, for example, the ways telehealth could help you if you have diabetes. You could do some or all of the following:
- Use a mobile phone or other device to upload food logs, medications, dosing and blood sugar levels for review by a nurse who responds electronically.
- Watch a video on carbohydrate counting and download an app for it to your phone.
- Use an app to estimate, based on your diet and exercise level, how much insulin you need.
- Use an online patient portal to see your test results, schedule appointments, request prescription refills or email your doctor.
- Order testing supplies and medications online.
- Get a mobile retinal photo screening at your doctor's office rather than scheduling an appointment with a specialist.
- Get email, text or phone reminders when you need a flu shot, foot exam or other preventive care.
The goals of telehealth, also called e-health or m-health (mobile health), include the following:
- Make health care accessible to people who live in rural or isolated communities.
- Make services more readily available or convenient for people with limited mobility, time or transportation options.
- Provide access to medical specialists.
- Improve communication and coordination of care among members of a health care team and a patient.
- Provide support for self-management of health care.
The following examples of telehealth services may be beneficial for your health care.
Your primary care clinic may have an online patient portal. These portals offer an alternative to email, which is a generally insecure means to communicate about private medical information. A portal provides a more secure online tool to do the following:
- Communicate with your doctor or a nurse.
- Request prescription refills.
- Review test results and summaries of previous visits.
- Schedule appointments or request appointment reminders.
If your doctor is in a large health care system, the portal also may provide a single point of communication for any specialists you may see.
Some clinics may provide virtual appointments that enable you to see your doctor or a nurse via online videoconferencing. These appointments enable you to receive ongoing care from your regular doctor when an in-person visit isn't required or possible.
Other virtual appointments include web-based "visits" with a doctor or nurse practitioner. These services are generally for minor illnesses, similar to the services available at a drop-in clinic. Some large companies provide access to virtual doctors' offices as a part of their health care offerings.
When you log into a web-based service, you are guided through a series of questions. The doctor or nurse practitioner can prescribe medications, suggest home care strategies or recommend additional medical care.
Similarly, a nursing call center is staffed with nurses who use a question-and-answer format to provide advice for care at home. A nursing call center doesn't diagnose an illness or prescribe medications.
While these services are convenient, they have drawbacks:
- Treatment may not be coordinated with your regular doctor.
- Essential information from your medical history may not be considered.
- The computer-driven decision-making model may not be optimal if you have a complex medical history.
- The virtual visit lacks an in-person evaluation, which may hamper accurate diagnosis.
- The service doesn't easily allow for shared doctor-patient decision-making about treatments or making a plan B if an initial treatment doesn't work.
A variety of technologies enable your doctor or health care team to monitor your health remotely. These technologies include:
- Web-based or mobile apps for uploading information, such as blood glucose readings, to your doctor or health care team
- Devices that measure and wirelessly transmit information, such as blood pressure, blood glucose or lung function
- Wearable devices that automatically record and transmit information, such as heart rate, blood glucose, gait, posture control, tremors, physical activity or sleep patterns
- Home monitoring devices for older people or people with dementia that detect changes in normal activities such as falls
Doctors can also take advantage of technology to provide better care for their patients. One example is a virtual consultation that allows primary care doctors to get input from specialists when they have questions about your diagnosis or treatment.
The primary care doctor sends exam notes, history, test results, X-rays or other images to the specialist to review. The specialist may respond electronically, conduct a virtual appointment with you at your doctor's office, or request a face-to-face meeting.
These virtual consultations may prevent unnecessary in-person referrals to a specialist, reduce wait times for specialist input and eliminate unnecessary travel.
An electronic personal health record system — often called a PHR system — is a collection of information about your health that you control and maintain. A PHR app is accessible to you anytime via a web-enabled device, such as your computer, laptop, tablet or smartphone.
In an emergency, a personal health record can quickly give emergency personnel vital information, such as current diagnoses, medications, drug allergies and your doctor's contact information.
A multitude of apps have been created to help consumers better organize their medical information in one secure place. These digital tools may help you:
- Store personal health information.
- Record vital signs.
- Calculate and track caloric intake.
- Schedule reminders for taking medicine.
- Record physical activity, such as your daily step count.
Technology has the potential to improve the quality of health care and to make it accessible to more people. Telehealth may provide opportunities to make health care more efficient, better coordinated and closer to home.
Research about telehealth is still relatively new, but it's growing. For example, studies have shown that both telephone-based support and telemonitoring of vital signs of people with heart failure reduced the risk of death and hospitalization for heart failure and improved quality of life.
While telehealth has potential for better coordinated care, it also runs the risk of fragmenting health care. Fragmented care may lead to gaps in care, overuse of medical care, inappropriate use of medications, or unnecessary or overlapping care.
The potential benefits of telehealth services may be limited by other factors, such as the ability to pay for them. Insurance reimbursement for telehealth still varies by state and type of insurance. Also, some people who would benefit most from improved access to care may be limited because of regional internet availability or the cost of mobile devices.
May 15, 2020
- Telehealth. U.S. National Institute of Biomedical Imaging and Biotechnologies. https://www.nibib.nih.gov/science-education/science-topics/telehealth. Accessed April 5, 2020.
- Telemedicine and telehealth . U.S. Office of the National Coordinator for Health Information Technology. https://www.healthit.gov/topic/health-it-initiatives/telemedicine-andtelehealth. Accessed Dec. 16, 2019.
- Kidney health in the digital age. U.S. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/kidney-health-in-the-digital-age. Accessed April 5, 2020.
- Totten AM, et al. Telehealth for acute and chronic care consultations. U.S. Agency for Healthcare Research and Quality. https://effectivehealthcare.ahrq.gov/products/telehealth-acute-chronic/research. Accessed Dec. 16, 2019.
- What are the benefits of personal health records? U.S. Office of the National Coordinator for Health Information Technology. https://www.healthit.gov/faq/what-are-benefitspersonal-health-records. Accessed Dec. 16, 2019.
- McSwain SD, et al. American Telemedicine Association operating procedures for pediatric telehealth. Telemedicineand e-Health. 2017; doi:10.1089/tmj.2017.0176.
- Weinstein RS, et al. Clinical examination component of telemedicine, telehealth, mHealth, and connected health medical practices. Medical Clinics of North America. 2018; doi:10.1016/j.mcna.2018.01.002.
- Rheuban KS, et al., eds. Workforce, definitions, and models. In: Understanding Telehealth. McGraw-Hill Education; 2019. https://accessmedicine.mhmedical.com. Accessed Dec. 16, 2019.
- Fillit HM, et al., eds. Telemedicine applications in geriatrics. In: Brocklehurst's Textbook of Geriatric Medicine and Gerontology. 8th ed. Elsevier; 2017. https://www.clinicalkey.com. Accessed Dec. 16, 2019.
- Felker GM, et al., eds. Disease management and telemedicine in heart failure. In: Heart Failure: A Companion toBraunwald's Heart Disease. 4th. ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Dec. 16, 2019.
- Vincent JL, et al., eds. Telemedicine in intensive care. 7th ed. In: Textbook of Critical Care. Elsevier; 2017. https://www.clinicalkey.com. Accessed Dec. 16, 2019.
- Telemedicine glossary. American Telemedicine Association. http://thesource.americantelemed.org/resources/telemedicine-glossary. Accessed Dec. 16, 2019.
- Bender W, et al. Intensive care unit telemedicine: Innovations and limitations. Critical Care Clinics. 2019; doi:10.1016/j.ccc.2019.02.011.
- What are the benefits of personal health records? HealthIT.gov. https://www.healthit.gov/faq/what-are-benefitspersonal-health-records. Accessed Dec. 16, 2019.