Telehealth is the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, health administration, and public health. This includes data sharing by way of patient portals and electronic medical records. Telehealth encompasses a broad range of technologies and services used to provide patient care, health education, public health services, and health administration remotely using telecommunications technologies. Telemedicine is sometimes used as a synonym but is actually a subset of telehealth. The Federation of State Medical Boards defines telemedicine as "the practice of medicine using electronic communication, information technology, or other means between a physician in one location, and a patient in another location, with or without an intervening health care provider." When rural settings, lack of transport, a lack of mobility, conditions due to outbreaks, epidemics or pandemics, decreased funding, or a lack of staff restrict access to care, telemedicine may bridge the gap and can even improve retention in treatment as well as provide distance-learning; meetings, supervision, and presentations between practitioners; online information and health data management and healthcare system integration. EHealth encompasses a wide range of applications, including but not limited to the following:
Two clinicians discussing a case via video conference; Robotic surgery performed through remote access; Physical therapy conducted using digital monitoring instruments, live feed, and application combinations; Diagnostic tests transferred between facilities for interpretation by a higher specialist; Home monitoring through continuous transmission of patient health data; Online consultations between patients and practitioners; Video remote interpretation services for clinical visits.
Telehealth versus telemedicine Telehealth is sometimes discussed interchangeably with telemedicine, the latter being more common than the former. Telehealth has been described as a disruptive innovation in healthcare because it enables medical services to be delivered remotely using communication technologies. The Health Resources and Services Administration distinguishes telehealth from telemedicine in its scope, defining telemedicine only as describing remote clinical services, such as diagnosis and monitoring, while telehealth includes preventative, promotive, and curative care delivery. This includes the above-mentioned non-clinical applications, like administration and provider education. The United States Department of Health and Human Services states that the term telehealth includes "non-clinical services, such as provider training, administrative meetings, and continuing medical education", and that the term telemedicine means "remote clinical services". The World Health Organization uses telemedicine to describe all aspects of health care including preventive care. The American Telemedicine Association uses the terms telemedicine and telehealth interchangeably, although it acknowledges that telehealth is sometimes used more broadly for remote health not involving active clinical treatments. eHealth is another related term, used particularly in the U.K. and Europe, as an umbrella term that includes telehealth, electronic medical records, and other components of health information technology.
Methods and modalities
Telehealth requires good Internet access by participants, usually in the form of a strong, reliable broadband connection, and broadband mobile communication technology of at least the fourth generation (4G) or long-term evolution (LTE) standard to overcome issues with video stability and bandwidth restrictions. As broadband infrastructure has improved, telehealth usage has become more widely feasible. Healthcare providers often begin telehealth with a needs assessment which assesses hardships that can be improved by telehealth such as travel time, costs or time off work. Collaborators such as technology companies can ease the transition. Delivery can come within four distinct domains: live video (synchronous), store-and-forward (asynchronous), remote patient monitoring, and mobile health. Audio-based telemedicine, primarily through telephone consultations, has been studied as a tool for managing chronic conditions. A systematic review of 40 randomized controlled trials found that audio-based care was generally comparable to in-person or video care, though with low to very low certainty of evidence.
Store and forward Store-and-forward telemedicine (also known as asynchronous telehealth) involves acquiring medical data (like medical images, biosignals etc.) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline. It does not require the presence of both parties at the same time. Dermatology (cf: teledermatology), radiology, and pathology are common specialties that are conducive to asynchronous telemedicine. A properly structured medical record, preferably in electronic form, should be a component of this transfer. The 'store-and-forward' process requires the clinician to rely on a history report and audio/video information in lieu of a physical examination.
Remote monitoring
Remote monitoring, also known as self-monitoring or testing, enables medical professionals to monitor a patient remotely using various technological devices. This method is primarily used for managing chronic diseases or specific conditions, such as heart disease, diabetes mellitus, or asthma. These services can provide comparable health outcomes to traditional in-person patient encounters, supply greater satisfaction to patients, and may be cost-effective. Examples include home-based nocturnal dialysis, improved joint management, and diabetes care using audio-based telemedicine with remote monitoring tools.
Real-time interactive Electronic consultations are possible through interactive telemedicine services which provide real-time interactions between patient and provider. Videoconferencing has been used in a wide range of clinical disciplines and settings for various purposes, including management, diagnosis, counseling, and monitoring of patients.
Videotelephony
Videotelephony comprises the technologies for the reception and transmission of audio-video signals by users at different locations for communication between people in real time. At the dawn of the technology, videotelephony also included image phones which would exchange still images between units every few seconds over conventional POTS-type telephone lines, essentially the same as slow scan TV systems. Currently, videotelephony is particularly useful to the deaf and speech-impaired who can use it with sign language and also with a video relay service, as well as to those with mobility issues or those who are located in distant places and are in need of telemedical or tele-educational services.
Categories
Emergency care
Common daily emergency telemedicine is performed by SAMU Regulator Physicians in France, Spain, Chile, and Brazil. Aircraft and maritime emergencies are also handled by SAMU centres in Paris, Lisbon and Toulouse. A recent study identified three major barriers to the adoption of telemedicine in emergency and critical care units. They include:
Regulatory challenges related to the difficulty and cost of obtaining licensure across multiple states, malpractice protection and privileges at multiple facilities Financial barriers including a lack of acceptance and reimbursement by government payers and some commercial insurance carriers, which places the investment burden squarely upon the hospital or healthcare system. Cultural barriers occurring from the lack of desire, or unwillingness, of some physicians to adapt clinical paradigms for telemedicine applications.
Emergency telehealth is also gaining acceptance in the United States. There are several modalities currently being practiced that include but are not limited to TeleTriage, TeleMSE, and ePPE. An example of telehealth in the field is when Emergency Medical Services (EMS) arrive on the scene of an incident and are able to perform an electrocardiogram (EKG) that is then sent directly to a physician at the hospital to be read, allowing for prompt care and management..
Telenursing
Telenursing refers to the use of telecommunications and information technology in order to provide nursing services in health care whenever a large physical distance exists between patient and nurse, or between any number of nurses. As a field, it is part of telehealth, and has many points of contact with other medical and non-medical applications, such as telediagnosis, teleconsultation, telemonitoring, etc. Telenursing is achieving significant growth rates in many countries due to several factors: the preoccupation with reducing the costs of health care, an increase in the aging and chronically ill population, and the increase in coverage of health care to distant, rural, small or sparsely populated regions. Among its benefits, telenursing may help solve increasing shortages of nurses, reduce distances and travel time, and keep patients out of hospital. A greater degree of job satisfaction has been registered among telenurses. In Australia, during January 2014, Melbourne tech startup Small World Social collaborated with the Australian Breastfeeding Association to create the first hands-free breastfeeding Google Glass application for new mothers. The application, named Google Glass Breastfeeding app trial, allows mothers to nurse their baby while viewing instructions about common breastfeeding issues (latching on, posture, etc.) or call a lactation consultant via a secure Google Hangout, who can view the issue through the mother's Google Glass camera. The trial was successfully concluded in Melbourne in April 2014, and 100% of participants were breastfeeding confidently.
Telepalliative care Palliative care is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. In the past, palliative care was a disease specific approach, but today the World Health Organization (WHO) takes a broader approach suggesting that palliative care should be applied as early as possible to any chronic and fatal illness. As in many aspects of health care, telehealth is increasingly being used in palliative care and is often referred to as telepalliative care. The types of technology applied in telepalliative care are typically telecommunication technologies, such as video conferencing or messaging for follow-up, or digital symptom assessments through digital questionnaires generating alerts to health care professionals. Telepalliative care has been shown to be a feasible approach to deliver palliative care among patients, caregivers and health care professionals. Telepalliative care can provide an added support system that enable patients to remain at home through self-reporting of symptoms and tailoring care to specific patients. Studies have shown that the use of telehealth in palliative care is mostly well received by patients, and that telepalliative care may improve access to health care professionals at home and enhance feelings of security and safety among patients receiving palliative care. Further, telepalliative care may enable more efficient utilization of healthcare resources, promotes collaboration between different levels of healthcare, and makes healthcare professionals more responsive to changes in patients' condition. Challenging aspects of the use of telehealth in palliative care have also been described. Generally, palliative care is a diverse medical specialty, involving interdisciplinary professionals from different professional traditions and cultures, delivering care to a heterogenous cohort of patients with diverse diseases, conditions and symptoms. This makes it a challenge to develop telehealth that is suitable for all patients and in all contexts of palliative care. Some of the barriers to telepalliative care relate to inflexible reporting of complex and fluctuating symptoms and circumstances using electronic questionnaires. Further, palliative care emphasizes a holistic approach that should address existential, spiritual and mental distress related to serious illness. However, few studies have included the self-reporting of existential or spiritual concerns, emotions, and well-being. Healthcare professionals may also be uncomfortable providing emotional or psychological care remotely. Palliative care has been characterized as high-touch rather than high-tech, limiting the interest in applying technological advancements when developing interventions. To optimize the advantages and minimize the challenges with the use of telehealth in home-based palliative care, future research should include users in the design and development process. Understanding the potential of telehealth to support therapeutic relationships between patients and health care professionals and being aware of the possible difficulties and tensions it may create are critical to its successful and acceptable use.
Telepharmacy
Telepharmacy is the delivery of pharmaceutical care via telecommunications to patients in locations where they may not have direct contact with a pharmacist. It is an instance of the wider phenomenon of telemedicine, as implemented in the field of pharmacy. Telepharmacy services include drug therapy monitoring, patient counseling, prior authorization and refill authorization for prescription drugs, and monitoring of formulary compliance with the aid of teleconferencing or videoconferencing. Remote dispensing of medications by automated packaging and labeling systems can also be thought of as an instance of telepharmacy. Telepharmacy services can be delivered at retail pharmacy sites or through hospitals, nursing homes, or other medical care facilities. This approach allows patients in remote or underserved areas to receive pharmacy services that would otherwise be unavailable to them, enhancing access to care and ensuring continuity in medication management. Health outcomes appear similar when pharmacy services are delivered by telepharmacy compared to traditional service delivery. The term can also refer to the use of videoconferencing in pharmacy for other purposes, such as providing education, training, and management services to pharmacists and pharmacy staff remotely.
Telepsychiatry
Telecare
Teledentistry
Teledentistry is the use of information technology and telecommunications for dental care, consultation, education, and public awareness in the same manner as telehealth and telemedicine.
Teleaudiology
Tele-audiology (or teleaudiology) is the utilization of telehealth to provide audiological services and may include the full scope of audiological practice. This term was first used by Gregg Givens in 1999 in reference to a system being developed at East Carolina University in North Carolina, US.
Teleneurotherapy Teleneurotherapy uses computers and communications technology to deliver neurotherapy remotely. Organisms receive physical stimuli, such as sounds (through mechanoreceptors and mitochondria across different organ systems) and light (through photoreceptors located in the retina and mitochondria) that alter neuronal activity in specific brain zones. Research indicates that systematic physical stimuli produced by standard electronic devices, such as tablets with headphones, may treat online injured nervous systems by modulating neuronal plasticity. Evidence suggests that teleneurotherapy may elevate neurological treatment if it considers the treating effect of a systematic abiotic impact of physical forces with key parameters of the mother-fetus interaction. Recent research implemented the APIN method (see above) in the online treatment of patients with different neurological conditions, which showed therapeutic effects. A review of the scientific literature has shown that measurable neuronal structural changes due to neuroplasticity through teleneurotherapy can appear within 2-3 months of such systematic impacts. The systematic effect of cognitive load from computer work, with a total training duration of 16 h (a few hours of weekly exercise), can significantly affect brain structure and function.
Teleneurology Teleneurology describes the use of mobile technology to provide neurological care remotely, including care for stroke, movement disorders like Parkinson's disease, seizure disorders (e.g., epilepsy), etc. The term teleneurology implies remote education, diagnostic assistance, and consultation, while it does not involve non-invasive remote targeted delivery of an energy stimulus to a specific neurological zone in the body to alter neuronal activity. The use of teleneurology gives us the opportunity to improve health care access for billions around the globe, from those living in urban locations to those in remote, rural locations. Evidence shows that individuals with Parkinson's disease prefer personal connection with a remote specialist to their local clinician. Such home care is convenient but requires access to and familiarity with the Internet. A 2017 randomized controlled trial of "virtual house calls" or video visits with individuals diagnosed with Parkinson's disease evidences patient preference for the remote specialist vs their local clinician after one year. Teleneurology for patients with Parkison's disease is found to be cheaper than in person visits by reducing transportation and travel time A recent systematic review by Ray Dorsey et al. describes both the limitations and potential benefits of teleneurology in improving care for patients with chronic neurological conditions, especially in low-income countries. White, well-educated and technologically savvy people are the biggest consumers of telehealth services for Parkinson's disease. as compared to ethnic minorities in the US.
Teleneurosurgery Telemedicine in neurosurgery was historically primarily used for follow-up visits by patients who had to travel far to undergo surgery. In the last decade, telemedicine was also used for remote ICU rounding as well as prompt evaluation for acute ischemic stroke and administration of IV alteplase in conjunction with neurology. From the onset of the COVID-19 pandemic, there was a rapid surge in the use of telemedicine across all divisions of neurosurgery: vascular, oncology, spine, and functional neurosurgery. Not only for follow-up visits, but it has gained popularity for seeing new patients or following established patients regardless of whether they underwent surgery. Telemedicine is not limited to direct patient care only; there are a number of new research groups and companies focused on using telemedicine for clinical trials involving patients with neurosurgical diagnoses.
Teleneuropsychology Teleneuropsychology is the use of telehealth/videoconference technology for the remote administration of neuropsychological tests. Neuropsychological tests are used to evaluate the cognitive status of individuals with known or suspected brain disorders and provide a profile of cognitive strengths and weaknesses. Through a series of studies, there is growing support in the literature showing that remote videoconference-based administration of many standard neuropsychological tests results in test findings similar to traditional in-person evaluations, thereby establishing the basis for the reliability and validity of teleneuropsychological assessment.
Telenutrition Telenutrition refers to the use of video conferencing/ telephony to provide online consultation by a nutritionist or dietician. Patient or clients upload their vital statistics, diet logs, food pictures, etc., on a telenutrition portal that is then used by the nutritionist or dietician to analyze their current health condition. The nutritionist or dietician can then set goals for their respective clients/patients and monitor their progress regularly by follow-up consultations. Telenutrition portals can help people seek remote consultation for themselves and/or their family. This can be extremely helpful for elderly or bedridden patients who can consult their dietician from comfort of their homes. Telenutrition showed to be feasible, and the majority of patients trusted the nutritional televisits, in place of the scheduled but not provided follow-up visits during the lockdown of the COVID-19 pandemic.
Telerehabilitation
Telerehabilitation (or e-rehabilitation) is the delivery of rehabilitation services over telecommunication networks and the Internet. Most types of services fall into two categories: clinical assessment (the patient's functional abilities in his or her environment) and clinical therapy. Some fields of rehabilitation practice that have explored telerehabilitation are: neuropsychology, speech–language pathology, audiology, occupational therapy, and physical therapy. Telerehabilitation can deliver therapy to people who cannot travel to a clinic because the patient has a disability or because of travel time. Telerehabilitation also allows experts in rehabilitation to engage in clinical consultation at a distance. Most telerehabilitation is highly visual. As of 2014, the most commonly used mediums are webcams, videoconferencing, phone lines, videophones, and webpages containing rich web applications. The visual nature of telerehabilitation technology limits the types of rehabilitation services that can be provided. It is most widely used for neuropsychological rehabilitation, fitting of rehabilitation equipment such as wheelchairs, braces, or artificial limbs, and in speech-language pathology. Rich web applications for neuropsychological rehabilitation (cognitive rehabilitation) of cognitive impairment (from many etiologies) were first introduced in 2001. This endeavor has expanded as a teletherapy application for cognitive skills enhancement programs for school children. Tele-audiology (hearing assessments) is a growing application. Physical therapy and psychology interventions delivered via telehealth may result in similar outcomes as those delivered in person for a range of health conditions. Two important areas of telerehabilitation research are (1) demonstrating equivalence of assessment and therapy to in-person assessment and therapy and (2) building new data collection systems to digitize information that a therapist can use in practice. Ground-breaking research in telehaptics (the sense of touch) and virtual reality may broaden the scope of telerehabilitation practice in the future. In the United States, the National Institute on Disability and Rehabilitation Research's (NIDRR) supports research and the development of telerehabilitation. NIDRR's grantees include the "Rehabilitation Engineering and Research Center" (RERC) at the University of Pittsburgh, the Rehabilitation Institute of Chicago, the State University of New York at Buffalo, and the National Rehabilitation Hospital in Washington, D.C. Other federal funders of research are the Veterans Health Administration, the Health Services Research Administration in the US Department of Health and Human Services, and the Department of Defense. Outside the United States, excellent research is conducted in Australia and Europe. Only a few health insurers in the United States, and about half of Medicaid programs, reimburse for telerehabilitation services. If the research shows that teleassessments and teletherapy are equivalent to clinical encounters, it is more likely that insurers and Medicare will cover telerehabilitation services.
Teletrauma care Telemedicine can be utilized to improve the efficiency and effectiveness of care delivery in a trauma environment. Examples include: Telemedicine for trauma triage: using telemedicine, trauma specialists can interact with personnel on the scene of a mass casualty or disaster situation via the internet using mobile devices to determine the severity of injuries. They can provide clinical assessments and determine whether those injured must be evacuated for necessary care. Remote trauma specialists can provide the same quality of clinical assessment and plan of care as a trauma specialist located physically with the patient. Telemedicine for intensive care unit (ICU) rounds: Telemedicine is also being used in some trauma ICUs to reduce the spread of infections. Rounds are usually conducted at hospitals across the country by a team of approximately ten or more people including attending physicians, fellows, residents, and other clinicians. This group usually moves from bed to bed in a unit, discussing each patient. This aids in the transition of care for patients from the night shift to the morning shift but also serves as an educational experience for new residents to the team. A new approach features the team conducting rounds from a conference room using a video-conferencing system. The trauma attending, residents, fellows, nurses, nurse practitioners, and pharmacists are able to watch a live video stream from the patient's bedside. They can see the vital signs on the monitor, view the settings on the respiratory ventilator, and/or view the patient's wounds. Video-conferencing allows remote viewers to conduct two-way communication with clinicians at the bedside. Telemedicine for trauma education: some trauma centers are delivering trauma education lectures to hospitals and health care providers worldwide using video conferencing technology. Each lecture provides fundamental principles, first-hand knowledge, and evidenced-based methods for critical analysis of established clinical practice standards, and comparisons to newer advanced alternatives. The various sites collaborate and share their perspective based on location, available staff, and available resources. Telemedicine in the trauma operating room: trauma surgeons are able to observe and consult on cases from a remote location using video conferencing. This capability allows the attending to view the residents in real time. The remote surgeon has the capability to control the camera (pan, tilt, and zoom) to get the best angle of the procedure while at the same time providing expertise in order to provide the best possible care to the patient.
Telecardiology ECGs, or electrocardiographs, can be transmitted using telephone and wireless. Willem Einthoven, the inventor of the ECG, actually did tests with the transmission of ECG via telephone lines. This was because the hospital did not allow him to move patients outside the hospital to his laboratory for testing of his new device. In 1906, Einthoven came up with a way to transmit the data from the hospital directly to his lab.
Transmission of ECGs One of the oldest known telecardiology systems for teletransmissions of ECGs was established in Gwalior, India, in 1975 at GR Medical College by Ajai Shanker, S. Makhija, P.K. Mantri using an indigenous technique for the first time in India. This system enabled wireless transmission of ECG from the moving ICU van or the patients home to the central station in ICU of the department of Medicine. Transmission using wireless was done using frequency modulation which eliminated noise. Transmission was also done through telephone lines. The ECG output was connected to the telephone input using a modulator that converted ECG into high-frequency sound. At the other end a demodulator reconverted the sound into ECG with a good gain accuracy. The ECG was converted to sound waves with a frequency varying from 500 Hz to 2500 Hz with 1500 Hz at baseline. This system was also used to monitor patients with pacemakers in remote areas. The central control unit at the ICU was able to correctly interpret arrhythmia. This technique helped medical aid reach in remote areas. In addition, electronic stethoscopes can be used as recording devices, which is helpful for purposes of telecardiology. There are many examples of successful telecardiology services worldwide. In Pakistan, three pilot projects in telemedicine were initiated by the Ministry of IT & Telecom, Government of Pakistan (MoIT) through the Electronic Government Directorate in collaboration with Oratier Technologies (a pioneer company within Pakistan dealing with healthcare and HMIS) and PakDataCom (a bandwidth provider). Three hub stations through were linked via the Pak Sat-I communications satellite, and four districts were linked with another hub. A 312 Kb link was also established with remote sites and 1 Mbit/s bandwidth was provided at each hub. Three hubs were established: the Mayo Hospital (the largest hospital in Asia), JPMC Karachi, and Holy Family Rawalpindi. These 12 remote sites were connected and an average of 1,500 patients were treated per month per hub. The project was still running smoothly after two years.
Wireless ambulatory ECG technology, moving beyond previous ambulatory ECG technology such as the Holter monitor, now includes smartphones and Apple Watches, which can perform at-home cardiac monitoring and send the data to a physician via the Internet.
Teleradiology
Teleradiology is the ability to send radiographic images (X-rays, CT, MR, PET/CT, SPECT/CT, MG, US...) from one location to another. For this process to be implemented, three essential components are required: an image-sending station, a transmission network, and a receiving-image review station. The most typical implementation is two computers connected via the Internet. The computer at the receiving end will need a high-quality display screen that has been tested and cleared for clinical purposes. Sometimes the receiving computer will have a printer for convenience. The teleradiology process begins at the image-sending station. The radiographic image and a modem or other connection are required for this first step. The image is scanned and then sent via the network connection to the receiving computer. Today's high-speed broadband-based Internet enables the use of new technologies for teleradiology: the image reviewer can now have access to distant servers in order to view an exam. Therefore, they do not need particular workstations to view the images; a standard personal computer (PC) and digital subscriber line (DSL) connection is enough to reach Keosys' central server. No particular software is necessary on the PC, and the images can be reached from anywhere in the world. Teleradiology is the most popular use for telemedicine and accounts for at least 50% of all telemedicine usage.
Telepathology
Telepathology is the practice of pathology at a distance. It uses telecommunications technology to facilitate the transfer of image-rich pathology data between distant locations for the purposes of diagnosis, education, and research. The performance of telepathology requires that a pathologist selects the video images for analysis and rendering diagnoses. The use of "television microscopy", the forerunner of telepathology, did not require that a pathologist have physical or virtual "hands-on" involvement in the selection of microscopic fields of view for analysis and diagnosis. A pathologist, Ronald S. Weinstein, M.D., coined the term "telepathology" in 1986. In an editorial in a medical journal, Weinstein outlined the actions that would be needed to create remote pathology diagnostic services. He and his collaborators published the first scientific paper on robotic telepathology. Weinstein was also granted the first U.S. patents for robotic telepathology systems and telepathology diagnostic networks. Weinstein is known to many as the "father of telepathology". In Norway, Eide and Nordrum implemented the first sustainable clinical telepathology service in 1989. This is still in operation, decades later. A number of clinical telepathology services have benefited many thousands of patients in North America, Europe, and Asia. Telepathology has been successfully used for many applications, including the rendering histopathology tissue diagnoses at a distance, for education and research. Although digital pathology imaging, including virtual microscopy, is the mode of choice for telepathology services in developed countries, analog telepathology imaging is still used for patient services in some developing countries.
Teledermatology
Teledermatology allows dermatology consultations over a distance using audio, visual and data communication, and has been found to improve efficiency, access to specialty care, and patient satisfaction. Applications comprise health care management such as diagnoses, consultation and treatment as well as (continuing medical) education. The dermatologists Perednia and Brown were the first to coin the term teledermatology in 1995, where they described the value of a teledermatologic service in a rural area underserved by dermatologists.
Teleophthalmology
Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology. Today, applications of teleophthalmology encompass access to eye specialists for patients in remote areas, ophthalmic disease screening, diagnosis and monitoring; as well as distant learning. Teleophthalmology may help reduce disparities by providing remote, low-cost screening tests such as diabetic retinopathy screening to low-income and uninsured patients. In Mizoram, India, a hilly area with poor roads, between 2011 and 2015, teleophthalmology provided care to over 10,000 patients. These patients were examined by ophthalmic assistants locally but surgery was done on appointment after the patient images were viewed online by eye surgeons in the hospital 6–12 hours away. Instead of an average five trips for say, a cataract procedure, only one was required for surgery alone as even post-op care like removal of stitches and appointments for glasses was done locally. There were large cost savings in travel as well. In the United States, some companies allow patients to complete an online visual exam and within 24 hours receive a prescription from an optometrist valid for eyeglasses, contact lenses, or both. Some US states such as Indiana have attempted to ban these companies from doing business.
Telesurgery
Remote surgery (also known as telesurgery) is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It is a form of telepresence. Remote surgery combines elements of robotics, cutting-edge telecommunications such as high-speed data connections, telehaptics and elements of management information systems. While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery. Remote surgery is remote work for surgeons, where the physical distance between the surgeon and the patient is immaterial. It promises to allow the expertise of specialized surgeons to be available to patients worldwide, without the need for patients to travel beyond their local hospital. Remote surgery or telesurgery is performance of surgical procedures where the surgeon is not physically in the same location as the patient, using a robotic teleoperator system controlled by the surgeon. The remote operator may give tactile feedback to the user. Remote surgery combines elements of robotics and high-speed data connections. A critical limiting factor is the speed, latency and reliability of the communication system between the surgeon and the patient, though trans-Atlantic surgeries have been demonstrated.
Teleabortion Telemedicine has been used globally to increase access to abortion care, specifically medical abortion, in environments where few abortion care providers exist or abortion is legally restricted. Clinicians are able to virtually provide counseling, review screening tests, observe the administration of an abortion medication, and directly mail abortion pills to people. In 2004, Women on Web (WoW), Amsterdam, started offering online consultations, mostly to people living in areas where abortion was legally restricted, informing them how to safely use medical abortion drugs to end a pregnancy. People contact the Women on Web service online; physicians review any necessary lab results or ultrasounds, mail mifepristone and misoprostol pills to people, then follow up through online communication. In the United States, medical abortion was introduced as a telehealth service in Iowa by Planned Parenthood of the Heartland in 2008 to allow a patient at one health facility to communicate via secure video with a health provider at another facility. In this model a person seeking abortion care must come to a health facility. An abortion care provider communicates with the person located at another site using clinic-to-clinic videoconferencing to provide medical abortion after screening tests and consultation with clinic staff. In 2018, the website Aid Access was launched by the founder of Women on Web, Rebecca Gomperts. It offers a similar service as Women on Web in the United States, but the medications are prescribed to an Indian pharmacy, then mailed to the United States. The TelAbortion study conducted by Gynuity Health Projects, with special approval from the U.S. Food and Drug Administration (FDA), aims to increase access to medical abortion care without requiring an in-person visit to a clinic. This models was expanded during the COVID-19 pandemic and as of March 2020 exists in 13 U.S. states and has enrolled over 730 people in the study. The person receives counseling and instruction from an abortion care provider via videoconference from a location of their choice. The medications necessary for the abortion, mifepristone and misoprostol, are mailed directly to the person and they have a follow-up video consultation in 7–14 days. A systematic review of telemedicine abortion has found the practice to be safe, effective, efficient, and satisfactory. In the United States, eighteen states require the clinician to be physically present during the administration of medications for abortion which effectively bans telehealth of medication abortion: five states explicitly ban telemedicine for medication abortion, while thirteen states require the prescriber (usually required to be a physician) to be physically present with the patient. In the UK, the Royal College of Obstetricians and Gynecologists approved a no-test protocol for medication abortion, with mifepristone available through a minimal-contact pick-up or by mail.
Other specialist care delivery Telemedicine can facilitate specialty care delivered by primary care physicians according to a controlled study of the treatment of hepatitis C. Various specialties are contributing to telemedicine, in varying degrees.Other specialist conditions for which telemedicine has been used include perinatal mental health. In light of the COVID-19 pandemic, primary care physicians have relied on telehealth to continue to provide care in outpatient settings. The transition to virtual health has been beneficial in providing patients access to care (especially care that does not require a physical exam e.g. medication changes, minor health updates) and avoid putting patients at risk of COVID-19. This included providing services to pediatric patients during the pandemic, where issues of last minute cancelation and rescheduling were frequently related to a lack of technicality and engagement, two factors often understudied in the literature. Telemedicine has also been beneficial in facilitating medical education to students while still allowing for adequate social distancing during the COVID-19 pandemic. Many medical schools have shifted to alternate forms of virtual curriculum and are still able to engage in meaningful telehealth e