6. Definition
• Telehealth, a term used interchangeably with telemedicine, has been
defined as the use of medical information that is exchanged from one
site to another through electronic communication to improve a
patient’s health.
• Dr. Pai’s opinion
• Telemedicine focus on treatment aspect
• Telehealth is broader than telemedicine e.g. preventive, administrative etc.
7
https://www.nejm.org/doi/full/10.1056/nejmsr1503323
39. Mayo Clinic Emergency Medicine Telehealth
40
Emergency Medicine Telehealth Respiratory Failure in Rural Setting: A Simulation
https://www.youtube.com/watch?v=KRO7ekb_dhY
40. Mayo Clinic Emergency Telehealth
41
Emergency Medicine Telehealth Respiratory Failure in Rural Setting: A Simulation
https://www.youtube.com/watch?v=KRO7ekb_dhY
54. Asyn vs Syn Telemedicine
55
https://www.researchgate.net/publication/316300531_Chapter_10_Exploring_Telemedicine_in_Emergency_Medical_Services_Guidance_in_Implementation_for_Practitioners/figures?lo=1&utm_source=google&utm_medium=organic
65. Stanford School of Medicine
Telemedicine Exam
https://medicine.stanford.edu/news/current-news/standard-news/virtual-physical-
exam.html
https://youtu.be/LCvLwnJjmTo
66
81. 82
Telemedicine นักศึกษาแพทย์ การเรียน การสอบ – Let the box filled with ideas (wordpress.com)
JMIR Medical Education - Incorporating Medical Students Into Primary Care Telehealth Visits: Tutorial
88. Perception of Telehealth
• Convenience
• Reduce travel Time and cost
• Mobility challenges
• Timeliness of care
90
89. Adding value to in-person care
• Convenience
• Reduce travel Time and cost
• Mobility challenges
• Timeliness of care
• Access to care in rural and urban communities
• Access to subspecialty care in austere communities
• Remote family presence
• Language interpretation services
• Multi-provider collaboration
• Device integration for remote patient monitoring
• Patient portal adoption and HIS/EHR integration
91
90. More Telemedicine in Urban than Rural
92
https://stateofreform.com/featured/2019/07/use-of-telehealth-rapidly-increased-according-to-fair-health-report/
124. 126
The Changing Fortunes of Telemedicine in Europe – Past, Present, and Future beyond COVID-19
(healthadvancesblog.com)
125. More care model coming
127
https://www.mckinsey.com/industries/healthcare/our-insights/how-care-at-home-ecosystems-can-
reshape-the-way-health-systems-envision-patient-care
150. Non-English and non-local language medical
translator
• Telemedicine
platform must allow
3rd party joining
• Certified + License
Medical Translator
152
154. Huh?
• “This study found no reported cases of medical malpractice in DTC
telemedicine. ” since 2018
• DTC = Direct-to-Consumer
156
https://jamanetwork.com/journals/jama/fullarticle/2729359
155. Why?
• Because of low risk and low acuity?
• Because patients are advised to seek in-person care when telehealth
care doesn’t suffice?
• Not attractive for litigation due to low dollar value
• Remember, the case settle outside the court might not be included
• Even of that, malpractice claims remain uncommon in telehealth
157
http://www.wsha.org/wp-content/uploads/Malpractice-in-Telehealth.pdf
156. OK, What do we have outside of
the court?
158
157. What do we have?
159
http://www.wsha.org/wp-content/uploads/Malpractice-in-Telehealth.pdf
158. Well, however…
• The number, still very low e.g. only 28 cases cumulative before
COVID-19
• Given the available data so far, malpractice claims remain uncommon
in telehealth
161
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9581762/
https://www.thedoctors.com/articles/your-patient-is-logging-on-now--the-risks-and-benefits-of-telehealth-in-the-future-of-
healthcare/?utm_source=pr&utm_medium=referral&utm_campaign=pr_external&utm_content=telehealth_whitepaper
159. Reimbursement
• “Low reimbursement for telehealth was viewed as a critical
disincentive. Without payment, it would be difficult for clinicians to
afford to provide the service, ”
• Telehealth payment parity
• Same or close reimbursement rate for telehealth and in-person visit
• For instance, for a routine primary care visit, such as for a 20- to 30-minute
visit with a physician, Louisiana Medicaid reimbursement for 2020 would be
$33.95 for a telehealth, compared with $62.65 for a physical visit.
• Having payment parity will improve telehealth use
162
https://jamanetwork.com/journals/jama/fullarticle/2766369
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790920
https://www.healthaffairs.org/do/10.1377/forefront.20210503.625394/full/
160. Store and Forward Telemedicine
Reimbursement in the US
163
https://www.cchpca.org/resources/state-telehealth-laws-and-reimbursement-policies-report-fall-2022/
165. Low Digital Literacy, socioeconomic associate
with more ‘audio’ telemedicine
168
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794548
166. Internet “Broadband” Coverage
• Internet Connection speed and internet speed is also important factor
for VDO Call Based Telemedicine (2x)
• No different on plain Telephone call telemedicine
169
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2797400
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06746-0
175. Take home message
• Telemedicine is not just a teleconference call, but a part of the care
• Telemedicine is not a substitute but complimentary to in-person care
• Know your customer!
178
176. “64% would have preferred to
see their nurse or doctor in
person”
NPR, the Robert Wood Johnson Foundation and the T.H. Chan School of Public
Health at Harvard Survey
https://media.npr.org/assets/img/2021/10/08/national-report-101221-final.pdf
https://www.npr.org/sections/health-shots/2021/10/18/1044358309/patients-say-telehealth-ok-but-doctor-visits-in-person-better
179