Currently, there is no single specific definition of telehealth. It can be defined as the integration of information technologies, medical and health technologies, telecommunication technologies and human-machine interface technologies to deliver healthcare and to promote the health status of people. More commonly, telehealth is used to describe the use of advanced telecommunication technologies to exchange health information and provide health care services across geographic, time, social, and cultural barriers (Reid, 1996). The CHIC (collaborative health informatics center) provides a broader definition of telehealth as "health care at a distance", which encompasses the use of telecommunications technologies in the health sector. As an innovative health delivery system, telehealth involves changes in both technology and the health care organizations that it is introduced into. So, we define telehealth as the extension of health care organizations in time and space by the use of information and telecommunications technologies with the objectives of promoting and facilitating people's health and well being.
Technology advances, the enabler of telehealth, play an important role in the development of telehealth industry. Following is a list of technologies appropriate for telehealth.
Videoconferencing is already a commonly used technology in telehealth to substitute for face-to-face experience. The recent introduction of desktop videoconferencing makes possible a complete interactive communication system consisting of television set, telephone and computer.
Audio-conferencing uses the telephone system for voice communications between individuals and groups. Audio-conferencing, simply made up of loudspeaker telephones and electronic bridges connecting multi-points, is easier to set up and costs less than other communication mode.
Audio-graphics uses the telephone system or a very narrow band of telecommunications to combine audio-conferencing with the transmission of graphics and other visual images such as scanned still pictures. Devices used in audio-graphics include facsimiles, tele-writers, and electronic blackboards/whiteboards, slow scan video, optical scanners and remote-controlled slide projectors.
Interactive multimedia technologies include laser disk and CD-ROM systems. With the availability of PCs and CD-ROM players, interactive multimedia systems, which is perceived as a flexible means for information delivery, provides a powerful platform for interactive learning.
Computer Networking (LANs/WANs)
Computer networking technologies, such as LANs and WANs, enable easy exchange of information regardless of geographic location. These technologies have considerable potentials for telehealth applications.
The Internet is a worldwide network of connected computers. It allows almost unlimited access to and exchange of information with any computer connected to the Internet. The Internet, on the one hand, is perceived to be revolutionary in driving the movement toward e-health, and on the other hand, it poses important management and legal challenges of how to ensure proper use of the Internet in health care.
Interactive satellite television
Interactive satellite television involves one-way delivery of live video, usually via satellite, with two-way interaction through the telephone system. Aside from the advantages of interactivity and active involvement when combined with audio- or video-conferencing, interactive satellite television brings economies of scale by enabling communications between the presenter and large groups of people.
Telehealth applications encompass a full range of health-related activities, which fall into four main categories.
teleconsulting, telepathology, teleradiology, telepsychiatry, tele-homecare, emergency medicine, cardiology, dermatology, ophthalmology, oncology, neurology, gastroenterology, rehabilitation, ultrasounds, remote diagnostic, dialysis, and robotic surgery.
Education and Training:
telementoring, continuing medical education, and distance learning
interactive administrative meeting, computerized patient record system, decision support systems, and quality management systems
electronic libraries and virtual laboratories
Section 223 of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) was enacted to enhance Medicare reimbursement for telehealth services. Important revisions of Medicare reimbursement for telehealth services are illustrated as follows:
BIPA expands eligible service areas for covered telemedicine services from restricted rural health shortage communities to include all non-metropolitan counties and existing urban Medicare demonstration sites. Additionally, Federal telemedicine demonstration projects as of December 31, 2000, may serve as the originating site regardless of geographic location.
Coverage of Telehealth
BIPA substantially improves the existing Medicare coverage of telehealth. The eligible telehealth services that can be billed to Medicare include consultation, office visits, individual psychotherapy and pharmacologic management delivered via a telecommunications system.
Conditions of Payment
While keeps in place the existing Medicare reimbursement for teleradiology and real-time teleconsultation using the interactive audio and video telecommunication technologies, BIPA allows store-forward telemedicine services to be billed to Medicare for Federal telemedicine demonstration programs conducted in Alaska and Hawaii. In addition, BIPA does not require that a practitioner present the patient for interactive telehealth services.
Methods of Payment
BIPA makes significant changes to methods of payment for telemedicine services. With regard to payment amount, BIPA specifies that payment for the professional service performed by the distant site practitioner (i.e., the specialist) will be equal to what would have been paid without the use of telemedicine. BIPA eliminates the required fee splitting practice between referring and consulting practitioners. BIPA also includes a $20 originating site facility fee in Medicare payment.
While the Medicare program has made great progress in telemedicine reimbursement, the Medicaid program, which has not formally defined telemedicine, gives each state of USA the option of providing reimbursement for telemedicine services. Nevertheless, because of the great potentials attached to telemedicine, such as improving access to health care for rural communities and reducing transportation costs, currently Medicaid reimbursement for telemedicine services is available in at least 18 states: Arkansas, California, Georgia, Iowa, Illinois, Kansas, Louisiana, Minnesota, Montana, Nebraska, North Carolina, North Dakota, Oklahoma, South Dakota, Texas, Utah, Virginia, and West Virginia. In addition, two states, Kentucky and Maine, are developing plans to allow Medicaid reimbursement for telemedicine. In Texas, the Medicaid agency recognizes only real-time teleconsultations using interactive teleconferencing. The Medicaid payment is on a fee-for-service basis, the same as that for the traditional, face to face health care services. Medicaid reimbursement is made at both ends (hub and spoke site) for the telemedicine services. Other health care providers, such as advanced nurse practitioners and certified nurse midwives are allowed to bill Medicaid, as are Rural Health Clinics and Federally Qualified Health Centers.