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Telehealth: Technology meets health care

See how technology can improve your health care.

How many times have you heard it said that the internet has changed modern life? Indeed, it's likely changed how you stay in touch with family and friends and buy goods and services. And it's probably even changed how you search for information about health problems.

Several telehealth tools are offered to help you manage your health care and receive the services you need. During the coronavirus disease 2019 (COVID-19) pandemic, many people used telehealth. People often still use it. Find out more about telehealth.

What is telehealth?

Telehealth is the use of digital information and communication technologies to access health care services remotely and manage your health care. Technologies can include computers and mobile devices, such as tablets and smartphones. This may be technology you use from home. Or a nurse or other health care professional may provide telehealth from a medical office or mobile van, such as in rural areas. Telehealth can also be technology that your health care provider uses to improve or support health care services.

The goals of telehealth, sometimes called e-health or m-health (mobile health), include the following:

• Make health care easier to get for people who live in communities that are remote or in the country.
• Keep you and others safe if you have an infectious disease such as COVID-19.
• Offer primary care for many conditions.
• Make services more easily offered or handy for people who have limited ability to move, time or transportation.
• Offer access to medical specialists.
• Improve communication and coordination of care among health care team members and a person getting care.
• Offer advice for self-management of health care.

Many people found telehealth helpful during the COVID-19 pandemic and still use it. Telehealth is being used more often.

Here are many examples of telehealth services that may be helpful for your health care.

Virtual visits

Some clinics may use telemedicine to offer remote care. For example, clinics may offer virtual visits. These can allow you to see a health care provider, mental health counselor or a nurse via online video or phone chats.

Virtual visits can offer care in many conditions such as migraines, skin conditions, diabetes, depression, anxiety, colds, coughs and COVID-19. These visits allow you to get care from a provider when you don't need or can't get an in-person visit.

Before your visit, your health care team may send you information or forms to fill out online and return to them. They may also make sure you have the technology you need. They'll check to see if you need to update or install any software or apps too. And they can tell you how to sign on and join the video chat for your visit. Also, the health care team can explain how to use the microphone, camera and text chat. If needed, ask a family member to help you set up the technology you need.

You only need a smartphone, tablet or computer with internet access to join the virtual visit. You can find a comfortable, quiet, private spot to sit during your visit. Your provider also meets from a private place.

Other options

Some people may use web or phone-based services for medical care or advice. When you log into a web-based service or call a service that offers primary or urgent care, you're guided through many questions. The provider or nurse practitioner can prescribe drugs. Or they may suggest home care tips or more medical care.

While these services are handy, they have drawbacks:

• Treatment may not be coordinated with your regular provider.
• Important details from your medical history may not be considered.
• The computer-driven model used to make decisions may not be right for you if you have a complex medical history.
• The service doesn't easily allow for you to make decisions with your provider about treatments.

Remote monitoring

Many technologies allow your provider or health care team to check your health remotely. These technologies include:

• Web-based or mobile apps for uploading data to your provider or health care team. For example, if you have diabetes, you may upload food logs, blood sugar levels and drugs that a nurse checks.
• Devices that measure and wirelessly send data, such as blood pressure, blood sugar and oxygen levels.
• Wearable devices that automatically record and send data. For example, the devices may record data such as heart rate, blood sugar, how you walk, your posture, tremors, physical activity or your sleep.
• Home monitoring devices for older people or people with dementia that can find changes in daily activities such as falls.
• Devices that send notifications to remind you to do exercises or take drugs.

Providers talking to providers

Providers can also use technology to give people better care. For example, in a virtual consultation, primary care providers can get input from specialists in other locations when they have questions about your diagnosis or treatment.

The primary care provider sends exam notes, history, test results, X-rays or other images to the specialist to review. The specialist may answer by email. Or they may do a virtual visit with you at your provider's office. They may also ask for a face-to-face meeting.

In some cases, a nurse or other health care professional may use technology to provide care from a medical office, clinic or mobile van in a rural area. They may call a specialist or provider at a medical clinic to do a remote consult.

These virtual consultations may prevent unnecessary in-person referrals to a specialist. They may also cut wait times for you to see a specialist. And they may remove the need for you to travel to a specialist.

Patient portal

Your primary care clinic may have an online patient portal. These portals offer a safer way of contacting your provider instead of email. A portal provides a safe online tool to do the following:

• Message your provider or a nurse.
• Ask for prescription refills.
• Review test results and summaries of earlier visits.
• Schedule visits or ask for appointment reminders for preventive care.

If your provider is in a large health care system, the portal may also provide one point of contact for any specialists you may see.

Personal health apps

Many apps have been made to help people 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 your calories.
• Schedule reminders for taking drugs.
• Record physical activity such as your daily step count.
• Personal health records

An electronic personal health record system (PHR system) is a collection of information about your health that you control and maintain. A PHR app is easy for you to see anytime via a web-enabled device, such as your computer, laptop, tablet or smartphone. A PHR also allows you to review your lab results, X-rays and notes from your provider. Your provider may give this to other providers with permission.

In an emergency, a personal health record can quickly give emergency staff vital information. For example, it can show your current conditions, drugs, drug allergies and your provider's contact details.

The potential of telehealth

Technology has the potential to improve the quality of health care. And technology can make it easier for more people to get health care.

Telehealth may offer ways to make health care more efficient, better coordinated and closer to home. You can go to a virtual visit anywhere — such as at home or in your car. And you don't need to travel to go to a virtual visit.

Telehealth can be useful so you can stay home if you're sick or if it's hard for you to travel. And you can use telehealth if you live far from a medical center. And many people have been able to keep distance from others at home and still receive care during the COVID-19 pandemic. And providers can diagnose and treat COVID-19 remotely.

Virtual visits can also provide you with the choice to meet with specialists who don't live where you do.

The limitations of telehealth

Telehealth has potential for better coordinated care. But it also runs the risk of gaps in care, overuse of medical care, inappropriate drug use or unnecessary care. Providers can't do a physical exam in-person, which can affect a diagnosis.

The potential benefits of telehealth services may be limited by other factors, such as costs. Insurance reimbursement for telehealth can vary by state and type of insurance in the U.S. But insurance keeps expanding for telehealth services in the U.S. And during the COVID-19 pandemic, insurance restrictions changed for a period of time. Check with your insurance company to see which providers have virtual visits covered by insurance.

Also, some people who need improved access to care may be limited because of not having internet access or a mobile device. People without internet access may be able to access telehealth services by using wireless internet offered at public places. For example, libraries or community centers may offer wireless internet for virtual visits that can take place in private rooms.

Sometimes technology doesn't work well. It's important to have a plan with your provider to call them by phone if there is an issue with the virtual visit.

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• Telehealth. National Institute of Biomedical Imaging and Bioengineering. https://www.nibib.nih.gov/science-education/science-topics/telehealth. Accessed May 6, 2022.
• What is telehealth? Telehealth.HHS.gov. https://telehealth.hhs.gov/patients/understanding-telehealth/. Accessed May 6, 2022.
• Ong MK, et al. Telemedicine for adults. https://www.uptodate.com/contents/search. Accessed May 5, 2022.
• Doraiswamy S, et al. Use of telehealth during the COVID-19 pandemic: Scoping review. Journal of Medical Internet Research. 2020; doi:10.2196/24087.
• Brotman JJ, et al. Providing outpatient telehealth services in the United States: Before and during coronavirus disease 2019. Chest Reviews. 2021; doi:10.1016/j.chest.2020.11.020.
• Telehealth: Defining 21st century care. The American Telemedicine Association. https://www.americantelemed.org/resource/why-telemedicine/. Accessed May 6, 2022.
• Mahtta D, et al. Promises and perils of telehealth in the current era. Current Cardiology Reports. 2021; doi:10.1007/s11886-021-01544-w.
• AskMayoExpert. COVID-19: Outpatient management. Mayo Clinic; 2021.
• Tapuria A, et al. Impact of patient access to their electronic health record: Systematic review. 2021; doi:10.1080/17538157.2021.1879810.
• Takahashi PY (expert opinion). Mayo Clinic. May 9, 2022.

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Mental Health

Virtual Visits: What Are They and What Can They Be Used For?

These days you can do almost everything online. Why shouldn’t you be able to see a doctor online too? Virtual visits or video visits make that a reality.

According to the American Telemedicine Organization , more than half of all U.S. hospitals use telemedicine, including Ochsner Health. A virtual visit is a video conference between you and your provider.

Virtual video visits are possible through two different Ochsner services:

• Ochsner Connected Anywhere offers urgent care on demand visits and  behavioral health scheduled appointments.
• Virtual Visits through MyOchsner are secure video appointments with an Ochsner provider.

What is Ochsner Connected Anywhere?

With an urgent care virtual visit, you can be seen by an expert provider 24 hours a day, seven days a week via a video connection just like Zoom, Skype or Facetime.

What conditions can be treated with an Ochsner Anywhere Care urgent care virtual visit?

• Cold/flu and cough
• Allergies and sinus issues
• Urinary tract infections
• Sore throats
• Stomach aches
• Shortness of breath

What behavioral health and well-being conditions can be treated with a scheduled virtual visit?

• Adolescent, marriage, family and grief and loss counseling
• Anxiety and panic attacks
• Attention deficit disorder
• Depression and mood disorders
• Eating disorders
• Postpartum depression
• Post-traumatic stress disorder (PTSD)

When necessary, your Ochsner Connected Anywhere provider will recommend you go to an emergency room. And the provider may recommend you make a follow-up appointment with a primary care provider or a specialist.

What is a MyOchsner virtual visit?

For some visits, your provider may be able to see you virtually through MyOchsner. Your care team may reach out to you if this is appropriate for your visit.

A virtual visit is a secure video appointment with your provider via your smartphone, tablet, laptop or desktop computer. This allows patients to conduct a traditional office visit with their provider electronically through the MyOchsner app or website portal without leaving home or work.

What are the technical requirements for a MyOchsner virtual visit?

• You must have a smartphone, mobile tablet, laptop and/or desktop computer.
• Microphone and webcam capabilities on your device
• iOS or Android operating system
• You can find the MyOchsner app in the App Store (iPhone) and Google Play Store (Android

Learn more about MyOchsner virtual visits.

You may also be interested in:

Augmented reality, virtual reality and medicine, telemedicine program treats stroke victims when time is crucial, what is ochsner on call.

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Telehealth, What It Is, and Its Pros and Cons

• Telehealth Overview
• What It Treats
• Disadvantages
• Preparing for an Appointment

Telehealth is a way to receive healthcare services remotely through electronic devices like your computer, tablet, or smartphone. Telehealth services come in different forms, such as live video or audio appointments, secured text messaging with your healthcare provider, or remote monitoring devices that allow your healthcare provider to track things like your blood sugar.

This article describes how telehealth started and the different ways that telehealth can and cannot be used. It also explores the advantages and disadvantages of telehealth and whether it is the best option for you.

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Telemedicine vs. Telehealth

Telehealth is sometimes referred to as telemedicine, but there are subtle differences. Telehealth refers to a variety of services, like connecting providers (such as labs and pharmacists), providing remote training, coordinating staff (like home health workers), and handling remote admissions. Telemedicine is just one aspect of telehealth focused solely on patient care.

Telehealth Overview and History

Telehealth has been around since long before the COVID-19 pandemic, but it was arguably during the lockdowns of 2020 that telehealth came into the public's consciousness.

Telehealth, as we know it today, began over 50 years ago when NASA developed telehealth services for astronauts on long-duration missions.

By the 1990s, telehealth was introduced as a means to deliver remote care to specific occupations, such as a system called Mednet that connected healthcare providers with workers on ships. Remote devices were soon after introduced that allowed healthcare providers to monitor people with sleep apnea or keep track of people with Alzheimer's disease using GPS technology.

The advent of high-speed internet, webcams, video chats, and specialized smartphone apps spurred the rapid adoption of telehealth in the early-2000s.

Services became sophisticated so that by the early part of the COVID-19 pandemic , the federal government not only aggressively adopted and increased awareness of telehealth but passed legislation that allowed for Medicare coverage of many at-home telehealth services.

A 2020 review published in BMC Public Health concluded that telehealth improved the delivery of healthcare during the pandemic, minimizing COVID-19 transmission and potentially reducing morbidity and deaths.

Telehealth Today

Today, telehealth encompasses a variety of virtual services that you can access through personal electronic devices, secure web portals, or dedicated monitoring devices. Although many people associate telehealth with "virtual health visits," it has come to mean much more than that.

Today, telehealth can serve many different purposes, such as:

• Enabling real-time visits with multiple providers or patients (such as for group therapy)
• Taking and sharing photos or videos of a skin rash, eye infection, or other symptoms
• Allowing you to direct message your provider with questions or requests (such as about medication doses, refills, or side effects)
• Receiving an email, phone, or text reminder about prescription refills or recommended health screenings
• Providing you with video instructions on how to use a medical device, such as a self-injector or at-home dialysis machine
• Remotely monitoring your blood sugar, heart rate, blood oxygen, sleep patterns, and other functions
• Providing you immediate secure access to electronic health records (EHRs)
• Linking you with an urgent care provider to get immediate treatment for uncomplicated conditions (like a cold sore )

Telehealth is even being explored as a way for surgeons to perform remote robotic surgery (" telesurgery ") for conditions like kidney tumors.

What Can Telehealth Treat?

Due to advances in video and medical technology and online security, telehealth can be utilized in many fields of practice once thought unimaginable. These include primary care, dermatology, dietetics, mental health, cardiology, endocrinology, and others.

Common conditions treated or managed with telehealth include:

• Headaches or migraines
• Colds, flu, or stomach aches
• Skin conditions such as acne or rashes
• Musculoskeletal conditions such as backaches
• Recurring conditions such as urinary tract infections or herpes
• Mental health problems such as anxiety or depression
• Gastrointestinal symptoms such as constipation
• Chronic medical conditions such as diabetes

Types of visits appropriate for telehealth include:

• Wellness visits
• Nutrition counseling
• Psychotherapy
• Physical or occupational therapy
• Some urgent or emergent care
• Obtaining referrals or prescriptions
• Fertility counseling
• Prescription management
• Lab test or X-ray results
• Post-surgical follow-up
• Follow-up appointments

Which Providers Use Telehealth Most?

According to the American Medical Association, the medical practitioners who utilize telehealth the most are radiologists (39.5%), psychiatrists (27.8%), and cardiologists (24.1%). The medical practitioners who utilize telehealth the least are obstetrician-gynecologists (9.3%), gastroenterologists (7.9%), and allergists/immunologists (6.1%).

Advantages of Telehealth

There are many benefits to telehealth as evidenced by its impact during the COVID-19 pandemic. Even after the pandemic officially ended, many of the benefits remain.

Increased Accessibility

Telehealth is particularly beneficial for people in rural or isolated locations who might otherwise skip checkups or have limited access to urgent care. Telehealth is also more accessible for people who have mobility issues or are restricted to bed because of illness or infection.

Telehealth can also help people with conditions like agoraphobia or social anxiety who find it difficult to leave the house or those with long or inconvenient work hours who can benefit from a telehealth appointment after normal office hours. People with chronic illnesses that are often stigmatized like major depression or HIV/AIDS may also be more likely to seek care through telemedicine.

Telehealth may also be a faster way to access services. In many cases, a telehealth provider can see you right away, sometimes within minutes or hours of making an appointment.

Reduced Hospitalizations

Telehealth may lead to reduced hospitalizations, in part because people can access care earlier before severe symptoms develop.

A 2015 study in the American Journal of Managed Care reported that among people with a prior cardiovascular event, those who used telehealth for follow-ups had 31% fewer hospital admissions than those who didn't.

A 2020 review in the Journal of Medical Internet Research similarly concluded that high-quality telehealth reduces the risk of all-cause or condition-related hospitalization by 4.8% and 15.6% respectively.

Cost-Effectiveness

Generally, telehealth appointments are less costly than in-person because more patients can be seen in the same timeframe with fewer support staff.

Beyond the actual out-of-pocket costs, telehealth can also be more cost-effective. Research indicates telehealth can offer additional cost-savings such as:

• Less work absenteeism and/or loss of income
• Reduced childcare costs
• Reduced travel expenses

Telehealth is also linked to increased independent living and better quality of life for those who are older or frail.

Avoiding Waiting Rooms

During the COVID-19 pandemic, access to healthcare services through telemedicine was implemented to help limit the spread of the virus. This is still an important reason why you may want to choose telemedicine services over in-person visits.

By using telemedicine during flu season or at times when these viruses are known to be spreading in your community, you may be able to avoid exposure to COVID-19 and other illnesses such as influenza and respiratory syncytial virus (RSV). This is particularly important for older people, people who are unvaccinated, or those who are immunocompromised.

Disadvantages of Telehealth

While telehealth may be more accessible for many people, it has its limitations and drawbacks that may make it less appropriate for certain groups.

Technical Barriers

Telehealth requires a certain level of technical literacy. Older populations and those with cognitive problems may not be able to utilize the services without a caregiver's help.

Older age is also associated with lower technology use. A 2022 study in Clinical Liver Disease reported that only 53% of adults 65 and over in the United States own a smartphone and only 59% have broadband access .

Other technical barriers include slow broadband speeds and unreliable internet service (particularly in remote regions) that can cause video calls to drop or interfere with streaming.

Telehealth requires a personal electronic device such as a computer or smartphone as well as internet access. Socioeconomic disparities alone may stand in the way of this.

A 2023 study from the University of Central Florida found that ethnic minorities and people with lower incomes are far less likely to access telehealth for economic reasons.

In Black communities especially, where poverty rates run high, people were less likely to engage in telehealth services than other ethnic groups. (In the same way, Black people are less likely to access healthcare in clinics due to cost and other social or economic reasons .)

Similarly, unemployed people are 15% less likely to access telehealth than those with a job.

Limitations in Care

There are also limitations as to what can and cannot be done via telehealth. In the end, some health services can’t be replicated virtually and require in-person visits.

These include appointments for:

• Blood and urine tests
• Physical diagnostic tests
• Physical examinations
• Shots or vaccinations
• Contraception placements
• Physical therapy

Because telehealth providers can't conduct a physical examination, there is also a greater risk of misdiagnosis associated with telemedicine services.

Regulations and Insurance Restrictions

Different states and insurance providers have different regulations and restrictions when it comes to telemedicine. For example:

• State regulations may create barriers to accessing telehealth, such as in-person visit requirements for people who need prescribed medication
• Health insurance companies may not cover telehealth services from providers located out of state
• There may be confusion about what types of telehealth services are covered by your provider

Privacy Concerns

Telehealth also comes with a broad range of privacy concerns, which may affect some groups more than others. For example:

• Data security can't always be guaranteed when using personal or public Wi-Fi networks, which means sensitive health information could be accessed by third parties.
• Some people do not have access to private spaces where they can use telehealth services.

There are steps you can take to ensure your privacy when using telehealth services:

• Make sure you are in a private location, such as a room with a locked door or a parked car.
• Turn off any devices that could record your conversation, such as security cameras, web cameras, smart speakers, etc.
• Avoid using a public computer, a work computer, or a public Wi-Fi network. Whenever possible, use your own device such as a phone, tablet, or laptop.
• Make sure your device has the latest operating system, including all recommended security updates.
• Choose a strong password when setting up your telehealth account. Your password should contain a mix of numbers, lowercase letters, capital letters, and symbols and should not be used on any other websites.
• Use encrypted email services when sending sensitive health information to your provider.

The Future of Telehealth

Telehealth was popular during the COVID-19 pandemic when lockdowns kept people confined to their homes and the healthcare system was overburdened. By 2022, however, telehealth use was significantly down, with an overall usage of around 31% compared to around 39% the previous year.

Other studies have found that there is still a preference for in-person telehealth services, with around 80% of providers saying they would rather provide limited or no telehealth services in the future, and only 36% of patients saying they prefer telehealth over an in-person visit.

Some analysts believe this indicates a trend towards limited telehealth services in the near future, though changes in access and improvements in home-based diagnostic tools could change this.

How to Use Telehealth

Before scheduling a telehealth appointment, speak with your provider and ask what platform or service they are using. It may be FaceTime on your iPhone, a Zoom call on your computer, or a secure portal on the internet.

If possible, do a test run to see if you can use the platform without freezing, dropped lines, sound problems, or pixelation (when the image breaks up).

How to Find a Telehealth Provider

If you have insurance, check directly with your insurance carrier when looking for a provider to see if they've partnered with any organizations that provide telehealth.

Some health insurance companies also provide searchable directories of healthcare providers with telehealth options. The providers in your health insurer's directory should also accept your insurance, though it's always a good idea to confirm this with the provider.

If you have Medicare or Medicaid, make sure that the service you plan to use is covered. While most telehealth services were covered by Medicare and Medicaid during the COVID-19 pandemic, some of those emergency concessions have since been withdrawn.

How to Prepare for a Telehealth Appointment

Once you are comfortable with the technology and out-of-pocket expense, you can prepare for the appointment by:

• Finding a private space where you can speak openly and confidentially
• Locating a well-lit spot so that your healthcare provider can see your face clearly
• Turning down any background noise
• Closing all other applications on your smartphone or laptop before the appointment begins

As with all other appointments, you can better prepare by writing down any symptoms or concerns you'd like to discuss. It is also important to be patient if your provider is running late as the same can happen with an in-office visit.

Telehealth involves the use of technology to deliver medical care remotely. This not only includes virtual visits on your smartphone, laptop, or tablet but also the sharing of electronic records, management of prescriptions and lab results, and the remote monitoring of conditions like diabetes.

The advantages of telehealth include convenience, generally lower costs, and more consistent management of medical conditions. Disadvantages include a lack of access to technology, a lack of technical literacy, the cost of telehealth for low-income people, and privacy concerns.

There are also limitations to the types of conditions that telehealth can and cannot treat.

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American Medical Association. Which medical specialties use telemedicine most?

Hirko KA, Kerver JM, Ford S, et al. Telehealth in response to the COVID-19 pandemic: Implications for rural health disparities . Journal of the American Medical Informatics Association . 2020;27(11):1816-1818. doi:10.1093/jamia/ocaa156

Obisike EE. The effectiveness of telemedicine on stigmatization and treatment burden in patients with health compromising lifestyles and chronic diseases: A critically appraised topic . Open Sci J . 2018;3(1).

Pande RL, Morris M, Peters A, et al.  Leveraging remote behavioral health interventions to improve medical outcomes and reduce costs .  Am J Manag Care . 21(2):e141-e151

Peters GM, KooijL, Lenferink A, van Harten WH, Doggen CJM. The effect of telehealth on hospital services use: systematic review and meta-analysis . J Med Internet Res. 2021 Sep;23(9):e25195. doi:10.2196/25195

Avidor D, Loewenstein A, Waisbourd M, Nutman A. Cost-effectiveness of diabetic retinopathy screening programs using telemedicine: a systematic review . Cost Effectiveness and Resource Allocation . 2020;18(1):16. doi:10.1186/s12962-020-00211-1

White-Williams C, Liu X, Shang D, Santiago J. Use of telehealth among racial and ethnic minority groups in the United States before and during the COVID-19 pandemic . Public Health Rep . 2023;138(1):149-156. doi:10.1177/00333549221123575

Price JC, Simpson DC. Telemedicine and health disparities . Clin Liver Dis (Hoboken). 2022 Apr;19(4):144–7. doi:10.1002/cld.1171

Centers for Disease Control and Prevention. Telehealth in rural communities .

Williams C, Shang D. Telehealth usage among low-income racial and ethnic minority populations during the covid-19 pandemic: retrospective observational study .  J Med Internet Res . 2023;25:e43604. doi:10.2196/43604

Holčapek T, Šolc M, Šustek P. Telemedicine and the standard of care: a call for a new approach? Front Public Health . 2023;11:1184971. doi:10.3389/fpubh.2023.1184971

American Academy of Family Physicians. Legal requirements for using telehealth services .

Houser SH, Flite CA, Foster SL. Privacy and security risk factors related to telehealth services - A systematic review . Perspect Health Inf Manag . 2023;20(1):1f.

U.S. Department of Health and Human Services. Telehealth privacy and security tips for patients .

Shilane D, Lu TH. Declining trends in telehealth utilization in the ongoing COVID-19 pandemic . J Telemed Telecare . 2023:1357633X231202284. doi:10.1177/1357633X231202284

SteelFisher GK, McMurtry CL, Caporello H, et al. Video telemedicine experiences in COVID-19 were positive, but physicians and patients prefer in-person care for the future . Health Aff (Millwood) . 2023;42(4):575-584. doi:10.1377/hlthaff.2022.01027

By Sarah Bence, OTR/L Bence is an occupational therapist with a range of work experience in mental healthcare settings. She is living with celiac disease and endometriosis.

What Is Telemedicine?

How is telemedicine defined, the benefits of telemedicine, is telemedicine as good as an office visit, how is telemedicine care provided to patients.

Telemedicine is the remote delivery of health care services using communication technology. Since the start of the COVID-19 pandemic , there has been a rapid increase in the use of remote doctor visits and “virtual” therapy. During the first quarter of 2020, the number of telehealth visits increased by 50% compared to 2019, according to the Centers for Disease Control and Prevention (CDC).

“Telemedicine at its simplest level is the practice of medicine using communication technology to deliver care with the patient at one site and the provider at another site,” says Brian Zack, MD, medical director of telehealth for University Hospitals and a pediatrician at UH Rainbow Babies & Children’s in Cleveland, Ohio.

Patients and providers can benefit from using telemedicine for a number of reasons, including access to specialists and the convenience of connecting with a health care professional without going to an office. Especially during COVID-19, the ability to receive care without risking exposure to the virus has allowed patients to keep appointments.

“There are certainly specialists that are more accessible,” Dr. Zack says, noting that less than 5% of UH psychology and psychiatry appointments were virtual before COVID-19. “Now, 93% to 97% are virtual, and there’s no indication that this will change. They are finding sessions to be more productive when people are at home and comfortable.”

You might be wondering if there is a difference between telemedicine and telehealth, two common terms associated with modern digital medicine. According to the American Academy of Family Practitioners (AAFP) telehealth is the broad category of electronic and telecommunications technologies and services used to provide care when a patient and provider are distant or between distant providers.

Telehealth encompasses:

• Clinical services
• Provider training
• Administrative meetings
• Continuing medical education
• Electronic medical record platforms
• Remote monitoring

Telemedicine has a narrower scope than that of telehealth and refers more specifically to using technology to deliver care at a distance, according to AAFP. “Telemedicine specifically refers to remote medical services,” says Sophia Tolliver, MD, clinical assistant professor of family medicine and a family medical physician at Ohio State University Family Medicine at Outpatient Care East, Columbus, Ohio.

Digital health is also a broad term that includes any way a patient and provider interact, from messaging in a patient portal to accessing lab results online, Dr. Zack adds. “Telehealth falls under that, and telemedicine is the delivery of care, whether a visit that’s audio or video,” he says.

Quality, access and cost are three main benefits of telemedicine, says Brian Skow, MD, chief medical officer at Avera eCare, a 24/7 virtual hospital that supports more than 500 facilities, hospitals, clinics and nursing homes in 36 states.

Quality : Quality speaks to improving care that patients receive remotely. Dr. Skow points to the American Board of Telehealth , a new organization that strives to educate the next generation of telemedicine providers to ensure proper credentials and training to “ensure patients receive the highest quality of care through their telemedicine visits.”

Access : Access is a huge benefit for patients. “Not only is telemedicine convenient because you can do it from your home, it opens up flexibility to access providers,” Dr. Zack says. It removes barriers like office location, for example.

Also, patients avoid waiting in a doctor’s office, Dr. Tolliver points out. “For patients, when you are getting ready to see your doctor, there are concerns like traffic, parking, wait times,” she says. “You check in and wait. You get your vitals done and wait. You get roomed and wait. If you are going to be waiting, what better place than at home?” A telemedicine visit can reduce a several-hours process to a far more efficient 20 to 30 minute virtual encounter.

Telemedicine can bring specialty care close to home for those living in rural areas where access to certain types of care can require travel, Dr. Skow adds. He explains how Avera eCare’s Sexual Assault Nurse Examiner (SANE) service line was developed because of a demand for these specialists in regions where a victim might have to be transported several hours from the local hospital to receive the examination. “Our virtual SANE program allows a nurser within our hub to assist a bedside provider [through video] with this much-needed examination,” he says, noting that telemedicine will continue to evolve as patient and provider needs are identified.

Cost : “We can lower the cost of care delivery and potentially increase revenue at local hospitals because they can admit patients that normally they could not. Telemedicine gives them resources to provide a higher level for specialty care, Dr. Skow says, relating that Avera eCare expands hospitals’ capabilities.

Cost savings also comes from efficiencies like eliminating drive time to a physician’s office, and for many patients, it will save them the cost of lost wages from taking time off from work.

Is telemedicine second to an in-person office visit? Not necessarily. For some types of care, telemedicine can be more effective and efficient, catering to patients’ needs without the hassle of showing up in an office.

“It’s not a binary choice,” Dr. Zack emphasizes. “You are not choosing a live vs. virtual visit. You are choosing the type of visit that is most clinically appropriate for you, and it’s up to the physician or office staff to help you figure out what that is.”

Sometimes, a visit starts virtually and leads to an in-person follow-up. “As a general pediatrician, I have been doing lots of virtual visits where we start the visit virtually, assess the patient, and I either feel comfortable that I can assess, diagnose and treat the symptoms, or I say, ‘I’m going to have to lay hands on. I’ll have to look in your throat or ears and listen to your heart,’” Dr. Zack says.

Some patients are much more comfortable having a telemedicine appointment and are more likely to schedule regular physicals or seek necessary care this way. “There are the patients we see every few years, and then when they come into the clinic, maybe their blood pressure is through the roof,” Dr. Tolliver says. “For those patients who feel barriers to getting into the office, telemedicine is an incentive to continue their care.”

Telemedicine is delivered asynchronously and synchronously. Telemedicine can also occur by telephone and include online interactions through a patient/provider portal.

“There is a direct video-to-video encounter, which we call interactive,” Dr. Skow says. “There is store-and-forward, like with dermatology. An original site will store pictures of, let’s say rashes, then forward it on to the dermatologist, who can sit down and ‘see’ a dozen patients in a short period of time and write recommendations.”

Remote patient monitoring is another version of telemedicine. In this case, patients are typically provided with medical devices like blood pressure monitors, weight scales or glucometers that they use in their homes to take readings. These devices communicate the results wirelessly to the patient’s provider who can interpret the data and manage the patient from afar.

Dr. Skow says synchronous video-to-video visits are highly beneficial because “the video connection adds so much.” For example, a phone call describing a wound might not reveal whether it requires sutures or surgical care. “That video encounter adds an extra piece of information that makes a huge difference with patient care.”

However, a live video experience is not always necessary for effective telemedicine. Filling medication requests or answering wellness questions can occur on a virtual platform, Dr. Tolliver says. “Patients can send messages and I can reply back, they can answer questionnaires online to help us gather information about certain diseases or medical history,” she says.

Telemedicine is not a brand-new phenomenon and began in the early 1920s with radio, evolving to the telephone and now involves robust digital technology, Dr. Zack points out. Through the generations, patients have adopted new ways of communicating and providers can leverage those to deliver care.

He says, “In today’s world, it’s really about using any device that improves communication and, therefore, improves delivery of care.”

Ultimately telemedicine is a tool that enables patients to receive the right level of care at the right time, at the most efficient cost.

• Brian Skow , MD, chief medical officer at Avera eCare
• Sophia Tolliver , MD, clinical assistant professor of family medicine and a family medical physician at Ohio State University Family Medicine at Outpatient Care East, Columbus, Ohio
• Brian Zack , MD, medical director of telehealth for University Hospitals and a pediatrician at UH Rainbow Babies & Children’s in Cleveland, Ohio
• American Academy of Family Physicians | What’s the difference between telemedicine and telehealth? | Last accessed March 2024
• American Board of Telehealth | Last accessed March 2024
• Centers for Disease Control and Prevention | Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic | Last accessed March 2024

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Why and When to Consider a Virtual Appointment

Do you skip going to the doctor because you find it inconvenient? Are you worried you might get sick or get someone else sick when visiting the doctor’s office? Then you might want to consider a virtual appointment.

With advances in telecommunication technology, seeing your health care provider by  telemedicine  is becoming more mainstream. 

At  East Side Primary Medical Care , we provide comprehensive primary care services for our patients who live in and around our office on Manhattan's Upper East Side. Our primary care physician,  Dr. Daniel Klein , wants to make it as easy as possible for our patients to get the care they need when they need it, which is why we offer virtual visits.

Here, we want to tell you why and when you should consider scheduling a virtual appointment. 

About virtual appointments

Virtual appointments, virtual visits, and telemedicine all mean the same thing: a  remote meeting  with your health care provider. Instead of coming to the office, you get the care you need by video or phone from a place that’s convenient and comfortable for you. 

All you need is a smartphone, computer, or tablet and an internet connection. You can even meet with your health care provider by phone if a video call isn’t possible.

With a virtual appointment there’s no need to travel to the office, which saves you time and money. 

Virtual appointments: why and when

Virtual appointments may not work for all health issues, but there are  many reasons  why you should consider seeing your provider remotely. For example, you might benefit from a virtual appointment if you have a hard time getting to the office because of lack of transportation. Or, you're too sick to get yourself to the office, but you need medical attention.

You may also want to consider virtual appointments if your work or family schedule makes it hard for you to get to the office. With virtual appointments, there’s no need to take a lot of time off from work or find a sitter to take care of your kids.

Virtual appointments also make a convenient option for follow-up visits if you have a chronic health condition like  diabetes  or high blood pressure. Many home blood glucose monitors and blood pressure machines allow you to send your data electronically to us so we can look at your numbers, talk to you about your health condition, and make updates to your plan as needed.

You may also consider a virtual appointment if you need a medication refill. 

What to expect

Like any visit with us, what happens during your virtual appointment depends on the reason for your visit. However, you can expect a thorough, patient-centered evaluation. 

Dr. Klein only requests your visit take place in a quiet, well-lit area so he can clearly hear and see you. Once you explain your health concern, Dr. Klein asks detailed questions to make sure he fully understands what’s going on so he can provide the right care.

He then makes recommendations, which may include lifestyle modifications and medications to treat your symptoms or condition. In some cases, we may request an in-office visit if we need more information that we can’t get through a virtual visit, such as a diagnostic test.

There are many reasons to consider a virtual appointment. If you have a health concern and can’t get to the office, now is a good time to schedule a virtual visit.  Call our office  or book your telemedicine appointment online today.

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How to perform a remote site visit A guideline on inspecting sites remotely

M ine site visits have long been held in high regard by prospectors, mining companies, regulators and investors. There is no doubt that having a technical team available to view any asset and provide observation and opinion is critical to understanding the asset. Most professionals agree that the cleanliness and hygiene of a site, facility, operation and their respective sub-parts reflect the management, project, operation and culture in general. Given the many restrictions on travel under the current circumstances and the possibility that at least some could remain in place for an extended time, remote visits where a professional or a team view and observe a site without being physically present demand special attention.

A site visit is normally used to validate information and data on a particular property. During any site visit, even a remote one, a number of peripheral observations happen naturally that can help form an opinion on the property, management and operation.

A remote site visit can never completely replace an actual site visit.

The intent of this guideline, adapted from a larger guideline on mine site visits, is to provide as much information as possible about remote site inspection to reduce the risk of a desktop-only or data-room review. The word “virtual” is not used here because this guideline covers actual site visits, where both images and sounds are live, not created in computer graphics. Many engineering, procurement and construction management companies produce virtual 3D models that are based on engineering design, but 3D models are generally not as-built, and in some cases, a follow up physical inspection is necessary for certain disciplines. A remote site visit can reduce the risk of reliance on reports and data without personal physical confirmation, and if performed properly, the information and data validation will be sufficient to reduce the risk associated with a desktop-only review.

Prior to a remote site visit

Prior to the site visit, the maximum possible data and information should be gathered. It is helpful to ensure that the data is evaluated, understood and assessed for any gaps that the site visit may need to address.

A parallel site team should be established to carry out the visit. Each remote discipline lead (RD) responsible for the visit should be assigned a local counterpart site inspector (SI) who will collect and transmit the required site sensory information. Although preferable, it is not required that the SI be a specialist in the discipline of the RD. Each SI should be provided instruction regarding how to properly use any communication, measurement or documentation equipment.

There are two parts to the technology required to carry out a remote site visit. The first is real-time communication methods, including compatible software for transmission and reception.

The second is the equipment and the software necessary to gather and transmit sensory information. This equipment can vary from a simple smartphone or tablet to surveying and measurement tools, including helmet cameras, eye glass cam- eras, microphones, and drones. Full agreement must be made on the technologies to be used for a remote site visit. A trial run is recommended to ensure the equipment and software works and to ensure the SI can successfully use it.

It is recommended that a two-part meeting between RDs and SIs be held to coordinate the site visit. The first part of the meeting should include the entire team to highlight the scope and intent of the visit*. The second part is for each RD to coordinate with his or her respective SI individually.

A number of activities need to be performed in preparation for part two, including but not limited to:

» The RD should provide an agenda and plan for the locations and areas they would like the SI to visit.

» The RD should send through the main elements to examine in each area. This will be the map/schedule for the remote site visit.

» The RD and SI should discuss the merits and weaknesses of the plan and finalize the actual “tour route” or “remote map.”

Mobile communication devices need to be tested in all regions of the visit and facility. If live communication is not possible, then the method for storage and transmission of information must be agreed to. A recorded method can be used for instruction and for feedback when live communication is not possible. Ensure all communications devices are fully charged and have backup sources of power.

The preferred methods of communication should be Wi-Fi or cellular, but if these are not available, then the site technology would govern how communication can happen between the RD and SI. A smartphone or helmet camera with audio is best suited for the SI.

Do a trial run. The SI should ensure that he or she can view what the camera lens captures. In the case of phones, the front camera can be used, and in the case of helmet cameras a remote or heads-up display can be used. Also make sure that photos can be taken directly by the RD through an application or by taking screen shots. The SI may also take and send photos to the RD. Upon approval and instruction, the SI can also take short videos as necessary.

During the actual inspection, the RD will instruct the SI to move the camera slow and steady for optimal video, or to zoom in and out as necessary or to move closer or farther away or a different direction, so there must be agreement on the camera movement terms (i.e., pan, directional movements, zoom in/out) and calibration.

For safety, it is critical to emphasize to the SI the importance of being aware of surroundings and watching where he or she is walking or stepping to avoid trips or falls. The SI must keep his or her eyes on the walk path at all times, not on the display of the device transmitting information.

Once the RD and SI work through the above details and do a trial run, they should be ready for the inspection. In some instances, periods with no Wi-Fi or cellular connection or delayed audio or video transfer may present a challenge, but it is generally not a significant barrier to completing an effective inspection.

Finally, a full schedule should be developed to match both physical inspection and interview time. This needs to be coordinated to have live conference video to discuss observations and address questions with operational, maintenance, project, and/or management personnel before the date of the visit to establish on-site availability or at minimum availability for communication.

Remote site visit

For a comprehensive remote inspection, it is recommended that the SI does two site inspections, on top of the trial run. This will allow for communications issues and errors, and for changes in real time differences in observance. Two separate inspections will provide the RD the opportunity to go through the first transmission and create a comprehensive list of items to capture that were missed during the first inspection. A second inspection will give the SI the opportunity to prepare to capture items that were not captured during the first inspection.

When possible, if matching “tour routes” or “remote maps” between multiple disciplines, it is possible that the second inspection can be a team or grouped inspection, with one SI serving multiple RDs. This is only possible once each RD has completed the first inspection, and has conferred with other RDs on the team to see if synergies exist.

A final report should be provided by the SI of what was inspected, viewed or observed. It should include schedules, dates and times as necessary, and it should be provided to the RD as proof and documentation of the remote site visit. This documentation is critical to establishing a record of what was requested to be viewed and what was actually viewed.

Technologies

There are a number of technologies that can serve for remote site inspection, including smartphones or tablets, helmet cameras, eye glass cameras, microphones and drones. Keep in mind that since there are practical limitations of control, timing, capacity, accuracy, depending on the complexity of the technology, more than one technology should be used to complete the remote site visit. The redundancy can bridge any gaps between the technologies used.

* See “WHY – Purpose of the Review and Visit” in Part 1 of “Mine and Mining Site Visit Guidelines – A Practical Approach.” � This column was excerpted and adapted from “Mine and Mining Project Site Visit Guidelines: A Practical Approach.” Read the full guidelines to performing remote site visits  here . Avakash Patel, P.Eng., is President – Advisory and Consulting Americas at RPMGlobal. He has worked for junior and major mining companies, as well as for top-tier EPCMs. He has been involved in various stages of project development and his experience spans multiple commodities and locations globally.

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Remote Visits

Have an appointment with your doctor over video to get care for a broad array of physical and mental health issues. Remote Visits are conducted and billed to insurance just like regular office visits, but done from the safety of home.

Time with your own provider

You can book Remote Visits with the provider of your choice — so you can get care from the person you feel most comfortable with during these turbulent times.

No waiting, no rushing

Remote Visits start at a set time, so you don’t have to wait for the next available provider. You can discuss any health topic — from prevention to mental health to chronic conditions.

The care you need, now

No need to put off looking after your health. Whether you’ve got back pain, insomnia, or a kid with a rash, Remote Visits let you get care without leaving home.

Two ways to get care over video

In addition to Remote Visits, we offer 24/7 Video Chats with our virtual medical team for urgent health issues, included in your membership at no extra cost.

One Medical care is available in our offices and over video in 12 metro areas .

How to book a Remote Visit

Remote Visits are easy to book through the One Medical app or website. Just go to the Office Visits section and follow the instructions. When it’s time to pick the visit type, choose “Remote Visit.”

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Why Remote Visits are important

Mike Richardson, MD, explains why Remote Visits are so vital to helping members get the care they need and stay connected to their provider in the era of COVID-19.

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This paper is in the following e-collection/theme issue:

Published on 27.3.2024 in Vol 26 (2024)

Outpatient Video Visits During the COVID-19 Pandemic: Cross-Sectional Survey Study of Patients’ Experiences and Characteristics

Authors of this article:

Original Paper

• Stefanie C van den Bosch 1 * , MD, DDS   ; 
• Demi van Dalen 2 * , MD   ; 
• Marjan Meinders 3 , PhD   ; 
• Harry van Goor 2 , MD, PhD   ; 
• Stefaan Bergé 1 , MD, PhD, DDS   ; 
• Martijn Stommel 2 * , MD, PhD   ; 
• Sandra van Dulmen 4, 5, 6 * , PhD  

1 Department Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, Netherlands

2 Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands

3 IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands

4 Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands

5 Faculty of Caring Science, Work Life and Social Welfare, University of Boras, Boras, Sweden

6 Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands

*these authors contributed equally

Corresponding Author:

Demi van Dalen, MD

Department of Surgery

Radboud University Medical Center

Geert Grooteplein Zuid 10

Nijmegen, 6525 GA

Netherlands

Phone: 31 243611111

Email: [email protected]

Background: During the first lockdown of the COVID-19 pandemic, an exponential increase in video consultations replacing in-person outpatient visits was observed in hospitals. Insight into patients’ experiences with this type of consultation is helpful for a broad, sustainable, and patient-centered implementation of video consultation.

Objective: This study aims to examine patients’ experiences with video consultation during the COVID-19 pandemic and identify discriminative patient and consultation characteristics to determine when video consultation is most feasible.

Methods: A cross-sectional survey study was conducted. Patients aged ≥18 years and scheduled for a video consultation at the outpatient clinic of a Dutch university medical center from August 2020 to December 2020 for all medical specialties were eligible. Patients’ experiences were explored through a study-specific survey using descriptive quantitative statistics. Open-ended questions were qualitatively analyzed and thematically categorized into appreciated aspects and aspects for improvement. Discriminative patient and consultation characteristics were identified using 3 distinctive survey items. Characteristics of patients who scored and those who did not score all 3 items positively were analyzed using binary logistic regression.

Results: A total of 1054 patients were included in the analysis. Most patients (964/1054, 91.46%) were satisfied with their video consultation, with a mean overall grade of 8.6 (SD 1.3) of 10. In the qualitative analyses, 70.02% (738/1054) of the patients cited aspects they appreciated and 44.97% (474/1054) mentioned aspects for improvement during their consultation. Patients with better self-rated health reported a positive evaluation significantly more often ( P= .001), which also held true for other medical specialties (vs surgical and nonsurgical specialties; P <.001).

Conclusions: Video consultation was perceived as highly satisfactory by patients during the COVID-19 pandemic, with the best experience reported by healthy participants and those undergoing their first consultation. Appreciated aspects are mainly at the individual professional level, organizational level, and innovation level itself. The aspects that were mentioned for improvement can be changed for the better.

Introduction

In the Netherlands, the COVID-19 pandemic led to the first lockdown from March 2020 to June 2020 and the second lockdown from mid-December 2020 to April 2021. Throughout these periods, in-person visits were minimized to reduce the risk of potential virus transmission. As a substitute for in-person visits, the use of video visits significantly increased across many medical specialties.

Video visits were already in practice on a limited scale in a wide range of contexts: for speech evaluation in patients with cleft palate [ 1 ], genetic counseling [ 2 ], follow-up after facial plastic surgery [ 3 ], and postoperative wound assessment [ 4 ]. Video visits were found to be satisfactory for patients [ 5 ] and enabled empathetic patient-professional relationships remotely [ 1 , 6 , 7 ]. However, large-scale implementation in daily practice was found to be challenging owing to the multilevel complexity of implementation, where people, organizations, and technology continuously interconnect and develop [ 8 - 11 ]. For example, attitudes and beliefs of individual professionals have been shown to act as both facilitators and barriers in the implementation of eHealth applications [ 8 ]. Furthermore, video visits appeared to be particularly successful in follow-up appointments, when a preexisting relationship of trust is established between the patient and clinician [ 10 ]. For instance, video visits were more easily adopted in follow-up care after cancer surgery compared with a multidisciplinary context of antenatal diabetes care [ 10 ].

Owing to the pandemic-driven, accelerated application of video visits, many clinicians gained experience with this mode of health care delivery. This way of providing care offers several advantages, including saving travel time and costs for both patients and their companions and the efficient use of health care resources, such as outpatient clinic space and support [ 12 - 14 ]. As we move into the post–COVID-19 era, video visits are expected to persist as a routine practice, but large-scale use has seemed to stagnate, presumably owing to a lack of guidance, vision, and attention to patients’ needs, as observed in the United States [ 15 , 16 ]. The use and implementation of video visits are expected to be most successful when tailored to the needs of patients, clinicians, and health care organizations [ 17 , 18 ]. Therefore, it is crucial to understand patients’ perspectives and experiences with video visits and identify specific patient groups that show a greater or lesser degree of appreciation for and suitability to video visits [ 19 ]. Large studies with diverse patient populations covering all medical specialties need to be conducted to learn more about patients’ perspectives [ 16 , 18 ]. However, we are concerned that only a limited number of studies have been published that evaluated video visits for patients within large, diverse populations. Consequently, this study contributes significantly to the existing body of knowledge in this area [ 20 - 22 ].

The primary aim of this study was to examine patients’ evaluations of video visits in the context of the COVID-19 pandemic. The secondary aim was to identify patient groups for whom video visits are relatively more suitable, given their positive experiences. With these results, the first step toward patient-tailored choices for type of visit can be made.

Study Design and Population

A cross-sectional study was conducted from August 2020 to December 2020 at the Radboud University Medical Center (Radboudumc). Zaurus was used as the video visit app, which is compatible with all smartphones and tablets. Patients were invited via email to register and download the app.

Patients scheduled for a video visit were automatically selected based on the registered mode of visit. Links to the questionnaire were sent by an independent research firm (Expoints) on behalf of the Radboudumc. Selected patients received the survey within 8 days after their visit via email to evaluate the visit and collect their sociodemographic details. The survey had to be completed within 2 weeks, and a reminder was sent 1 week after the initial invitation. An incomplete survey could be saved to be completed later (within 2 weeks). No reminder for completion was sent.

All patients aged ≥18 years who received a video visit at an outpatient clinic at Radboudumc were eligible for inclusion. When a patient had multiple video visits in the selected period, the most recent video visit was selected.

Patients were excluded if they had cognitive problems; had difficulties with reading and understanding Dutch owing to a hindering language barrier; were deceased at the time of selection; completed a survey regarding video visits in the 180 days before the start of our study; completed a survey regarding their admission experience or experience with an in-person visit 30 days before the start of our study; or were admitted to the hospital, as priority was given to the patient experience survey regarding admission. In addition, when the video visit was a follow-up visit after giving birth or when the video visit was replaced with another visit modality, the patient was excluded.

Ethical Considerations

All patients participated voluntarily and anonymously in the survey and gave informed consent to use their data in accordance with the General Data Protection Regulation. Ethics approval was requested and waived by the local Medical Research Ethics Committee of Radboudumc (CMO [committee on research involving human subjects] Oost-Nederland; registration number 2021-8415).

A combined survey was used, which consisted of the Patient Experience Monitor (PEM) for adult outpatient experience [ 23 ], developed by the Dutch Federation of University Medical Centers, and the patient satisfaction survey for video visits created by Hanna et al [ 7 ]. This combined survey was constructed after extensive deliberation by an expert panel. In this process, a literature review of surveys specifically about video visits was performed. The experts found the survey by Hanna et al [ 7 ] to be the most suitable for the aim of our study.

The PEM survey was constructed by adapting a validated Picker Institute survey following a comprehensive theory-driven approach of item selection by an expert panel, cognitive interviews with patients, analysis of psychometric properties, and member checking. This survey of 14 items represents eight key domains of person-centered care: (1) fast access to reliable health care advice; (2) effective treatment delivered by trusted professionals; (3) continuity of care and smooth transitions; (4) involvement and support for family and caregivers; (5) clear information, communication, and support for self-care; (6) involvement in making decisions and respect for preferences; (7) emotional support, empathy, and respect; and (8) attention to physical and environmental needs [ 24 ]. The Picker Institute surveys are measures for evaluating patients’ experiences in outpatient and inpatient clinical care and have been validated and extensively used in university medical centers in the Netherlands since 2019 [ 25 ]. The PEM survey was adapted to the videoconferencing setting by rephrasing the questions. Overall, 2 items were open-ended questions ( Multimedia Appendix 1 ). Quantitative analyses of the PEM survey were based on individual survey items, whereas open-ended questions were analyzed using qualitative methods.

The 13-item survey by Hanna et al [ 7 ] is designed according to the principles of survey development for telemedicine to evaluate patients’ experiences with video visits in pain clinics [ 26 ]. This survey was translated into Dutch, and 1 item was removed, as it was already covered by the PEM survey ( Multimedia Appendix 1 , items 16-27). In total, 4 items were rephrased based on the advice of the patient communication experts. Analysis of the survey by Hanna et al [ 7 ] is based on an overall sum score, where a higher overall sum score represents greater satisfaction. For correct analysis and to calculate an overall sum score, the 3 negatively phrased questions (items 17, 21, and 23) were reversed (eg, “No, definitely not” was converted to “Yes, definitely”), according to protocol.

Finally, a question was added to assess the visit by assigning a score on a scale ranging from 1 to 10 (with 10 being most positive). The survey was conducted according to CHERRIES (Checklist for Reporting Results of Internet-Based e-Surveys; Multimedia Appendix 2 ) [ 27 ].

Statistical Analysis

Quantitative analysis.

Descriptive statistics were used for the closed-ended items ( Multimedia Appendix 1 , items 1-11 and 16-27). To identify patient and visit characteristics associated with positive evaluation of video visits, 4 authors found consensus upon the 3 key items from the survey by Hanna et al [ 7 ] that stood out the most (item 18: “the care I received by a video visit was just as good as with an in-person appointment”; item 22: “I was comfortable talking by video to the healthcare professional”; item 27: “I would recommend the video visit option to other patients”). Throughout the paper, these 3 items have been referred to as “crucial” components of the survey by Hanna et al [ 7 ], as they best displayed a positive experience.

Patient and visit characteristics were determined for the group answering the 3 crucial items positively. In this analysis, the following characteristics were included: sex, age category, level of education, self-rated health, type of visit (first vs follow-up), and medical specialty (surgical, nonsurgical, or other). High self-rated health was defined as a score that indicates “very well” or “excellent.”

Statistical analysis was performed using SPSS Statistics (version 25; IBM Corp). Binary logistic regression analysis was used to calculate differences in patient and visit characteristics between the patient subgroup that scored positively on all crucial items and the patient subgroup that did not score positively, as the dependent variable was not normally distributed.

Qualitative Analysis

Qualitative analysis was performed on the open-ended questions (items 13 and 14) to identify appreciated aspects and aspects for improvement for video visits. Overall, 2 authors (SCvdB and DD) independently categorized all the answers into six categories of factors that influence the implementation of innovations: (1) the innovation itself, (2) the individual professional, (3) the patient, (4) social context, (5) organizational context, and (6) economic and political context [ 28 ]. In case of conflicts in the categorization, consensus was reached through discussion between the authors. Responses including multiple levels within a single response were counted as individual items. Examples of answers for both aspects in each category have been cited in the Results section.

Quantitative Results

From August 2020 to December 2020, a total of 1244 surveys were completed, with a response rate of 28.32% (1244/4392). After excluding 15.27% (190/1244) of the patients who reported that the visit was either a telephone consultation or replaced by telephone after technical difficulties, 84.73% (1054/1244) of the surveys were used in the analysis.

Table 1 shows the patients’ demographics. An equal distribution across age categories was observed. Clinical genetics, neurology, and medical oncology accounted for 65.84% (694/1054) of the total number of evaluated video visits, whereas the distribution across the other medical specialties varied widely. The numbers of first and follow-up visits were equal, with most follow-up visits (480/1054, 45.54%) performed by a known clinician. After a video visit, 36.91% (389/1054) of the patients had to make an appointment for an additional in-person visit or medical examination. A follow-up visit via video was planned in 40.32% (425/1054) of the evaluated video visits. Clinicians from medical oncology and neurology more frequently scheduled an in-person follow-up visit for their patients—18.6% (40/215) and 23.3% (50/215), respectively. Moreover, in 39.7% (69/174) and 14.4% (25/174) of cases, the visits provided by clinical genetics and neurology respectively, were followed by a consecutive visit for additional (diagnostic) testing.

The overall grading for the video visit had a mean of 8.6 (SD 1.3; median 9) of 10. For 5 PEM items, >80% of the patients answered positively, that is, patients waited no longer than 5 minutes, clinicians had read their medical records well, patients received understandable answers, patients trusted the clinician, and patients had enough time to discuss their problems with the clinician. Refer to Table 2 for details about the responses of patients.

For the remaining 6 items, more than 21% stated that the item was either not applicable or answered positively. For instance, 80.25% (829/1033) indicated not receiving any new medication for the question about whether the professional explained the adverse effects of new medication. Analysis of the items in the survey by Hanna et al [ 7 ] showed that 91.46% (964/1054) of the patients was satisfied with their video visit, 66.98% (706/1054) found it to be just as good as an in-person visit, and 68.69% (724/1054) would recommend video visits to other patients, as shown in Table 3 .

Of 1054 patients, 574 (54.46%) answered all 3 crucial items on the survey by Hanna et al [ 7 ] positively, 234 (22.2%) answered 2 of 3 positively, 138 (13.09%) answered only 1 item positively, 72 (6.83%) patients answered “not applicable” or responded negatively, and 36 (3.42%) responses were missing. Patient and visit characteristics of patients who positively answered all 3 crucial Hanna [ 7 ] items versus the group who did not are shown in Multimedia Appendix 3 .

Results of the binary logistic regression are shown in Table 4 . Negative association was found between the positive evaluation of a visit and the surgical and “other” medical specialties (B=−0.64; P <.001). Positive evaluation was also associated with the patient category who described their health as “very well” (B=1.12; P =.01). Sex, age, and educational status had no influence on whether a patient rated the visit positively. In addition, the reason for the visit was not found to have any influence on the positive evaluation of a video visit.

a ENT: ear, nose, and throat.

b Includes trauma surgery, visceral surgery, surgical oncology, and vascular surgery.

c OMF: oral and maxillofacial surgery.

a The total in some sections is not 100% owing to missing responses.

a Nagelkerke R 2 =0.08.

b N/A: not applicable.

Qualitative Results

Table 5 displays the frequencies of appreciated aspects and aspects for improvement. Most patients (738/1054, 70.02%) cited appreciated aspects of the use of video visits in the open-ended questions. The most frequently cited appreciated aspects were expressed at the individual professional level, followed by the organizational context level and the innovation level. Few aspects were mentioned at the patient level, economic and political context level, and social context level. Approximately half of the patients (474/1054, 44.97%) cited aspects for improvement. Most were cited at the innovation, organizational context, and patient levels. In contrast, no improvable aspects were reported at the economic and political context level.

a Overall, 70.01% (738/1054) of the patients cited appreciated aspects.

b Responses including multiple levels within a single response were counted as individual items.

c Overall, 44.97% (474/1054) of the patients cited aspects for improvement.

The perceived ease of use and audio-visual quality were frequently mentioned as appreciated aspects. The intuitive character of the app was seen as valuable, as not all patients were familiar with using web-based apps. Patients appreciated the audio-visual quality, allowing the video visit to be a good alternative for an in-person visit. However, not all the patients experienced the same ease of use, as the most reported aspect for improvement was poor audio and video quality, sometimes clearly caused by an unstable internet connection. Although Zaurus is compatible with all electronic devices, users have reported issues with video size specifically on smartphones ( Textbox 1 ).

Appreciated aspect

“The application is straightforward and easy to understand. Conversation went well, the doctor even asked me if I could hear her well.” [Female; aged 18-34 y; clinical genetics]

Aspect for improvement

“The video connection was really bad. Almost immediately the app crashed, and the audio stuttered, so I could not understand what the doctor was saying. After two attempts, we continued the visit by telephone.” [Female; aged 65-79 y; excluded for further analysis; clinical genetics]

Individual Professional

Patients often mentioned what they valued in the clinician’s professional behavior, such as their attitude, and communicative style. In contrast, a lack of adequate or visible body language and lack of knowledge about someone’s medical history were mentioned as aspects for improvement ( Textbox 2 ).

“There is still a kind of personal touch in the contact, which is nice for the perception as well. The doctor radiated tranquility and was understanding, and she had read my personal record well. That gives me confidence.” [Female; aged 55-64 y; clinical genetics]

“The doctor did not look at us during the video visit. Both my daughter, who was also present, and I had noticed. That felt a little awkward. He was mainly looking down (I guess at a file or something like that, which was in front of him).” [Female; aged 80-99 y; clinical genetics]

The possibility to have face-to-face interactions remotely was often mentioned as valuable, as patients were able to watch the clinicians’ nonverbal reactions. It made video visits a safe alternative for patients with a weak immune system, for example, during the pandemic. Personal lack of experience with video visits was a hindering factor, as not all patients were familiar with the use of videoconferencing apps. Some of them preferred an in-person visit, as they felt uncomfortable owing to inexperience ( Textbox 3 ).

“It is nice to see the doctor, but for a first meeting, it is something I need to get used to. However, this feels safer regarding the coronavirus and a vulnerable immune status.” [Female; aged 35-54 y; neurology]

“I’d rather have the first visit in person. Maybe I’m old fashioned, but I prefer physical contact, even during this COVID pandemic. Feelings and emotions might be more difficult to pick up on screen.” [Male; aged 55-64 y; neurology]

Social Context

The possibility of the involvement of others, such as next of kin or other family members, was one of the mentioned appreciated aspects. Creating a culture in which a patient can share their preference or opt for a certain visit modality could stimulate the use of video visits. Patients expressed that they would like to have a say in choosing which visit modality they like, especially when the nature of the visit is sensitive ( Textbox 4 ).

“On time, pleasant conversation, space for questions, clear explanation. It was nice that my partner could join with his phone.” [Female; aged 18-34 y; reproductive medicine]

“It was a shame they communicated the results by a video visit. I was shocked and found they acted a bit indignant about my reaction. I was not capable anymore to follow the conversation.” [Female; aged 18-34 y; clinical genetics]

Organizational Context

Internet-based assistance, clear instructions, and time management by the clinician during the visit were often mentioned as appreciated aspects at this level. Many patients were called in advance of the visit to check for technical problems. However, patients were not always informed correctly if the visit would start later than scheduled, and in some cases, patients received the link for the video visit just before the visit started, which was an aspect for improvement ( Textbox 5 ).

“The support was really good, as I am not so technical and there was enough explanation. Great.” [Female; aged 55-64 y; clinical genetics]

“I would like to receive a notification when the doctor is held up, especially when it’s a first visit. Also, I would like to receive a heads up when I get another doctor than the one the appointment was originally scheduled with.” [Male; aged 55-64 y; medical oncology]

Economic and Political Context

Time and financial savings were identified as valuable aspects at the economic and political context level. Patients often cited less travel time and costs as beneficial. There were no improvable aspects reported at the economic and political context level ( Textbox 6 ).

“It is pleasant that there is no need for traveling to the hospital (regarding travel time and travel distance) and still have ‘personal’ contact with the doctor through a video connection.” [Male; aged 35-54 y; neurology]

Principal Findings

In this study, we comprehensively analyzed evaluations of visits via video to a tertiary clinic made by a large, diverse patient population, including appreciated aspects and aspects for improvement. Most patients (964/1054, 91.46%) evaluated the video visits positively, with significantly more positive evaluations when the visits were provided by a clinician from “other” medical specialties, as compared to surgical and nonsurgical specialties, or when the patient rated their health status as “very well.” The appreciated aspects were mostly at the individual professional level, whereas aspects for improvement were reported at the innovation level itself.

Comparison With Previous Studies

Our finding that high self-rated health of patients is an influencing patient characteristic for suitability of video visits echoes the finding that patients with less complex, more straightforward clinical needs are more suitable candidates for video visits than those with complex, high-risk diseases [ 10 , 29 ]. Similar findings were identified in an oncological study wherein telemedicine was received favorably for low-acuity cancer care [ 16 ]. In contrast to findings that video visits appear to be more appropriate when the clinician knows the patient beforehand and when it is a follow-up visit [ 10 ], we found that the reason for the visit did not have any influence on whether patients rated the video visit positively. Remarkably, the medical specialty providing the visit was found to be a significant associated factor. Nonsurgical visits were found to be most suitable for telemedicine. One can imagine that these visits are less dependent on physical examination, such as internal medicine or dermatology, for instance, as these specialties can easily review laboratory abnormalities or skin disorders on screen [ 30 ]. In addition to specific aspects of the visit that may depend on the medical specialty, other dimensions or elements during the visit could affect the patient experience, such as the communication strategy used by the clinician [ 31 ]. Nonetheless, more studies are needed to get a clear overview about whether medical specialty is a truly discriminative characteristic or whether it is more dependent on the attitude of certain clinicians and patient groups.

Qualitative analysis of the open-ended questions revealed both facilitating and hindering factors for broad implementation and upscaling of video visits. Following Grol and Wensing [ 28 ], these factors were categorized into innovation, professional, patient, social context, organizational context, and economic and political context levels. Appreciation was mostly centered on the professionals’ skill in adapting communication to the video setup; however, there was scope for improvement among some individuals, as they might benefit from investing additional effort in making visual contact. The way in which the video visits were organized was also highly valued, especially for the provision of technical support to patients as and when needed.

The attitude of the clinician during the video visit was one of the most frequently mentioned aspects for improvement. The bedside manner, which may be better described as the “webside” manner, of a clinician refers to how the clinician behaves, approaches the patient, and communicates during the visit. Clinicians sometimes seem to lack awareness of how their nonverbal behavior looks on screen, as was also shown by a study that analyzed a large data set of >5000 patients [ 32 ]. Patients prefer increased expression of nonverbal empathy from clinicians when they show signs of distress. Inadequate nonverbal communication and body language are often reported as barriers for telemedicine adoption [ 3 , 33 , 34 ]. Despite expert recommendations dating back several years to raise awareness for nonverbal and paraverbal communication, our study also indicates that there is still considerable scope for improvement and training at the clinician level [ 31 , 35 ].

In accordance with several survey studies conducted during the pandemic, our response rate was low. This might be explained by the questionnaire fatigue that was frequently observed during the COVID-19 pandemic, as patients received multiple questionnaires and messages from the outpatient clinic, apart from research [ 36 ].

Regarding future perspectives, clinicians should seek guidelines to assess the suitability of a video visit, and the following recommendations might be useful. The Dutch Center of Expertise on Health Disparities recommends checking the patients’ digital skills beforehand, providing digital support, and evaluating whether the information is correctly understood through techniques such as “teach back” at the end of the visit [ 37 ]. Video consulting guidelines advise considering several factors while deciding whether video visits may be suitable, such as whether there is an established relationship with the patient, whether it entails nonurgent care, whether there is a need for physical examination, and whether there are factors in favor of the patient staying at home [ 38 ].

Limitations

The findings of this study must be considered in the light of some limitations. First, our study might have been exposed to selection and sampling biases for several reasons. It was an “open” survey, where patients could decide voluntarily whether they would participate in the survey, which might have led to a sample of patients that is not representative of the entire population of the hospital. In addition, owing to the exclusion criteria, not all video visits were evaluated.

Second, the validity of the combined survey was not tested. As the analysis of our data was reported at the item level, calculating the internal consistency using Cronbach α was not applicable. PEM is known to be a validated survey; however, the psychometric properties of the survey by Hanna et al [ 7 ] are not known and should be determined. As the PEM items were rephrased to the videoconferencing setting, reliability of this new PEM survey will have to be reassessed.

The educational status of patients attending a university medical center is, in general, often higher than the mean educational status of the general population. In our study population, 44.4% (468/1054) of the patients were highly educated, compared with 30% in the Dutch population in 2018 [ 39 ]. As teaching hospitals and referring hospitals might serve different populations, the generalizability of our results might be limited, and further studies including different types of hospitals are recommended.

A total of 139 patients reported a failed video visit and noted that the visit was replaced by telephone. However, the exact number of times this occurred is not known, as not all patients might have reported this failure, which also may have resulted in selection bias.

In this evaluation, we deliberately focused on the patient evaluation of video visits. As it is known that patients and clinicians have different views about quality of information and visits [ 40 - 42 ], the clinicians’ point of view should also be explored for a comprehensive evaluation of the use of video visits. Health care providers, such as clinicians, might experience different barriers and facilitators compared with patients, thus influencing the successful implementation of video visits. Key barriers to successful implementation such as the lack of training and motivation to offer video visits need to be addressed [ 3 , 8 , 43 , 44 ].

Conclusions

Video visits were perceived as highly satisfactory by patients during the COVID-19 pandemic, with the best experiences reported by healthy participants and participants who scheduled a visit with a clinician outside the realms of surgical and nonsurgical medical specialties, such as clinical genetics or radiotherapy. Appreciated aspects were mainly at the individual professional level, organizational level, and at the level of the innovation itself. The mentioned aspects for improvement can be changed for the better.

The findings cannot be directly generalized as they were collected in a university medical center with a specific patient population, but they provide additional results for understanding the suitability of video visits in a broad patient population. To be able to truly tailor the use of video visits to patients’ needs, a patient-centered perspective involving both patients and health care professionals is needed.

Data Availability

The data used in this study will be made available by the authors upon reasonable request.

Authors' Contributions

SCvdB, MM, MS, and SvD contributed to the study’s conception and design. SCvdB and DvD performed the statistical analyses. SCvdB managed the project administration and data curation. SCvdB, DvD, MS, and SvD drafted the manuscript. HvG, SB, MS, and SvD supervised the research project. SCvdB and DvD contributed equally to this work and share first authorship. MS and SvD contributed equally to this work and share senior authorship. All authors interpreted the data, critically revised the paper, and approved the final version of the paper.

Conflicts of Interest

None declared.

Survey on video visits during the COVID-19 outbreak (August 2020 to December 2020).

CHERRIES (Checklist for Reporting Results of Internet-Based e-Surveys) checklist.

Patient and visit characteristics of those who positively answered all 3 crucial items in the checklist by Hanna et al [ 7 ] versus the group that did not answer positively.

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• Barsom EZ, Meijer HA, Blom J, Schuuring MJ, Bemelman WA, Schijven MP. Emergency upscaling of video consultation during the COVID-19 pandemic: contrasting user experience with data insights from the electronic health record in a large academic hospital. Int J Med Inform. Jun 2021;150:104463. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Kim J, Kim S. Physicians' perception of the effects of Internet health information on the doctor-patient relationship. Inform Health Soc Care. Sep 2009;34(3):136-148. [ CrossRef ] [ Medline ]
• Murray E, Lo B, Pollack L, Donelan K, Catania J, Lee K, et al. The impact of health information on the internet on health care and the physician-patient relationship: national U.S. survey among 1.050 U.S. physicians. J Med Internet Res. 2003;5(3):e17. [ FREE Full text ] [ CrossRef ] [ Medline ]
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Abbreviations

Edited by T Leung; submitted 16.05.23; peer-reviewed by AW Zahoor, J Hayden; comments to author 25.10.23; revised version received 08.12.23; accepted 31.01.24; published 27.03.24.

©Stefanie C van den Bosch, Demi van Dalen, Marjan Meinders, Harry van Goor, Stefaan Bergé, Martijn Stommel, Sandra van Dulmen. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 27.03.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

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Telehealth and remote patient monitoring

The ability to monitor certain aspects of a patient's health from their own home has become an increasingly popular telehealth option. Remote patient monitoring lets providers manage acute and chronic conditions. And it cuts down on patients' travel costs and infection risk.

On this page:

How to use remote patient monitoring with telehealth, how to help patients use at-home health monitors, billing and payment for remote physiologic monitoring.

Remote patient monitoring pairs well with telehealth when patients need to be monitored for certain health conditions. It can also prevent health complications in patients who aren’t able to easily travel.

There are many symptoms and conditions that can be tracked through remote patient monitoring, including:

• High blood pressure
• Weight loss or gain
• Heart conditions
• Chronic obstructive pulmonary disease
• Sleep apnea

Many of the devices that patients will use may be familiar to them, including:

• Weight scales
• Pulse oximeters
• Blood glucose meters
• Blood pressure monitors

Other conditions require more complicated devices that will require patient training, including:

• Apnea monitors
• Heart monitors
• Specialized monitors for dementia and Parkinson’s disease
• Breathing apparatuses
• Fetal monitors

As the popularity and convenience of telehealth grows, so does remote patient monitoring. More providers are implementing remote patient monitoring for several reasons, including:

• Advanced medical technology
• A growing awareness of telehealth for providers and patients
• The ability to monitor and prevent serious complications in remote locations

A practical guide to remote patient monitoring

Learn simple, essential tips for leveraging remote patient monitoring in your practice  (PDF), including applications for care management, implementing best practices, and more.

Remote monitoring may be new for your patients, and for you also. The best way to help your patients is to be informed about the devices you will be using. This includes how they work and how you will receive the data from the device.

Make sure patient understands why you are prescribing at-home health monitors

There are a number of ways to share information with your patients:

• A telehealth appointment before they begin using the device
• A follow-up telehealth appointment after they’ve been using the device for several days
• An email or downloadable PDF explaining remote patient monitoring for their condition or symptoms

Help your patient understand how to use their device

Some products, such as a weight scale, may not need a lot of explanation. But other devices may be more high tech or confusing for patients. Here’s a few tips:

• Walk your patient through operating the device in a telehealth appointment
• Refer your patient to an at-home medical equipment provider in their area who can set them up with the device and provide support
• Tell your patient what types of readings you will get from their device and how you will receive that information
• Make sure your patient has written instructions they can refer to, including paper copies, email, or downloadable PDF
• Encourage your patient to write down their questions and either call your office, email you the questions through a patient portal, or request a follow-up telehealth appointment
• Have a member of your staff let your patient know when you are receiving their information correctly from the device

Talk to your patients about the benefits of remote patient monitoring

Some patients will need in-person testing, diagnostics, or monitoring. This depends on their condition, Internet capabilities, or personal preferences and abilities. But there are many ways that remote patient monitoring can help with chronic conditions, pregnancy complications, and short-term illness.

These benefits include:

• Reduced hospitalizations
• Shorter hospital stays if the patient can be discharged with a remote monitoring device to use at home
• Fewer visits to the emergency room
• Better health outcomes for patients in rural areas
• Better preventative management for chronic conditions
• Reduced risk of illnesses for patients and health care workers

Tip:  Medicare uses the term, “remote physiologic monitoring” in their coding and billing language. Remote physiologic monitoring (RPM) is a set of codes that describes non-face-to-face monitoring and analysis of physiologic factors used to understand a patient’s health status.

Billing for Medicare

While private insurance companies set their own terms, Medicare has its own payment policies.

They include:

• An established patient-physician relationship is required
• Consent to receive remote physiologic monitoring services at the time services are furnished is allowed
• Physicians and non-physician practitioners who are eligible to furnish evaluation and management services (E/M) may bill for remote physiologic monitoring services

Guidelines for remote physiologic monitoring services billed to CPT codes 99453 and 99454

• Physiologic data must be electronically collected and automatically uploaded to the secure location where the data can available for analysis and interpretation by the billing practitioner
• The device used to collect and transmit the data must meet the definition of a medical device as defined by the FDA
• Remote physiologic monitoring data must be collected for at least 16 days out of 30 days
• Remote physiologic monitoring services must monitor an acute care or chronic condition
• The services may be provided by auxiliary personnel under the general supervision of the billing practitioner

For specific codes and requirements for Medicare’s remote physiologic monitoring coverage, visit the Medicare Physician Fee Schedule page from the Centers for Medicare & Medicaid Services .

Billing for private insurance

Check with the patient’s insurance company for information on their billing and reimbursement policies.

Billing for Medicaid

Each state has its own remote patient monitoring billing and reimbursement policies. Providers can check their state’s policies at the National Policy Center - Center for Connected Health Policy  .

More resources:

Telehealth in Rural Communities  — Centers for Disease Control and Prevention (CDC)

Creating an emergency plan

How to ensure patient safety during a telemedicine visit.

Telehealth policy

Federal legislation continues to expand and extend telehealth services.

Mountain lion that killed man and injured his brother is euthanized in California

A mountain lion attack left one person dead and another injured in a remote area of Northern California on Saturday, officials said.

The two brothers, 18 and 21, were antler shed hunting in Georgetown, California, when the mountain lion attacked the pair, according to the El Dorado County Sheriff’s Office.

The California Department of Fish and Wildlife said the mountain lion involved in the attack was euthanized on Saturday.

The department said Sunday that its Wildlife Forensics Laboratory matched DNA from the mountain lion, which was found near Georgetown, to DNA found at the scene of the attack.

The younger brother called 911 at 1:13 p.m. to report being separated from his older brother during the attack, officials said.

Deputies began searching the area, and at around 1:46 p.m., they found the mountain lion crouched next to the older brother. Shots were fired to scare off the animal.

The 21-year-old was dead by the time deputies reached him. The 18-year-old suffered “traumatic injuries” to his face and was taken to a local hospital for treatment, the sheriff’s office said.

Authorities have not released the names of the victims.

Georgetown is about 40 miles northeast of Sacramento.

Mountain lion attacks on humans are rare. The California Department of Fish and Wildlife has reported 13 attacks in the state since 2004, with only one being fatal.

Katherine Itoh is a news associate for NBC News.