Telemedicine process going on on line in the image also known as telehealth

Meaning Definition Benefits and Technology of

Tele medicine

These services are conductible via telemedicine portals, also referable as telemedicine or telehealth platforms. Different Entities define telemedicine (sometimes also known as telehealth) similarly as follows:

Telemedicine Definition by the World Health Organization

Telemedicine is a kind of medical and health service. The distance is a key factor. All medical treatments such as medical diagnosis, treatment, consultation and evaluation are realizable through information and communication technology, also referable as electronic medical and electronic health care.

 Tele-medicine Industry Definition

Relying on computer technology, remote sensing, telemetry, the remote control technology gives full play to the advantages of medical technology and medical equipment in large hospitals or specialist medical centers. It provides long-distance medical information for people with poor medical and health conditions and special circumstances. And as service, it is a medical service with design to improve the capacity of medical services, reduce medical expenses and meet the health care needs of more people.

American Telemedicine Definition

Telemedicine refers to the use of computer technology, remote sensing, telemetry and remote control technology to give full play to the advantages of medical technology and medical equipment in large hospitals or specialized medical centers, and to injuries in remote areas, islands or ships with poor medical conditions. Conduct remote diagnosis, treatment and consultation.

 China Health Care Commission’s Definition of Telemedicine

Telemedicine Service is a medical institution (hereinafter reference as the Inviting Party) that invites other medical institutions (hereinafter reference as the invitees) to use the communication, computer and network technologies (hereinafter reference as information technology) to treat the medical institutions. Medical activities in which patients provide technical support. Medical institutions use information technology to provide medical services directly to patients outside medical institutions, which are telemedicine services.

Telemedicine Services Include

Telemedicine services include remote pathology diagnosis, remote medical imaging (including imaging, ultrasound, nuclear medicine, electrocardiogram, electromyography, EEG, etc.) diagnosis, remote monitoring, teleconsultation, remote clinic, remote case discussions and so on.

 

From the analysis of all prominent definitions of telemedicine, it is derivable that it is a new medical service designed to improve the level of diagnosis and medical care, reduce medical expenses, and meet the health needs of the broad masses of the people. At present, telemedicine technology finds its evolution from the initial TV monitoring and telephone remote diagnosis to the use of high-speed networks for integrated transmission of digital, image and voice, and real-time communication of voice and high-definition images, providing a modern medical application. A broader space for development. The development of developed countries in this field has a history of more than 40 years, and underdeveloped countries are receiving attention and development only in the recent years. Generally, it is synonymous to telehealth, telecare, ehealth, ecare, eDoctor, eOPD, emedicine, online medicine, online doctor, online health, eHospital, Online Hospital, and so on.

 

Telemedicine Platforms – Telehealth Platforms

The online platform or site or portal on which the telemedicine software hosts or runs runs enabling the features of utility of telemedicine is called a telemedicine platform or telehealth platform. Here the word platform is also changeable with the words portal and site. For e.g. VVFIT.COM is a telemedicine platform, telemedicine Portal or a telehealth portal.

 

Table of Content

1. Historical evolution

2. Research content

3. Main features

4. Basic use

5. Application areas

    i. Media

    ii. Communication

    iii. Medical

6. Development status

▪ Western

▪ Asian

7. Telemedicine policy pilot

 

Historical evolution of Telemedicine in America, World and Asia

Telemedicine in a Broad World Sense: Use of telematics, holographic imaging, new electronic technology and computer multimedia technology to leverage the advantages of medical technology and equipment in large medical centers to provide long-distance medical information for poor medical conditions, special environments and service. It includes all medical activities such as remote diagnosis, remote consultation and nursing, distance education and telemedicine information services. In a narrow sense it refers to telemedicine including remote imaging, remote diagnosis and consultation, remote care and other medical activities.

How did telemedicine evolve in the USA?

American Evolution of Telemedicine: In the late 1950s, American scholar Wittson first used the two-way television system for medical treatment. In the same year, Jutra and others created teleradiology. Since then, the United States is using electronic communication and electronic technology for medical activities, and the word “Telemedicine” is appearing. Now domestic experts are uniformly translating it as “telemedicine.” American futurist Alvin Tof Gong predicted many years ago, “In the future medical activities, doctors will face the computer and diagnose and treat patients based on various information from patients who are coming from afar on the screen.” This situation is now present. The expectations are that global telemedicine will make more progress in the near future.

The development of this field abroad is nearly 40 years old, and it started late in Asia and China. China began to regulate and promote telemedicine services since the 1990s, and successively introduced relevant policies.

 

What is generic Asian state policy on Telemedicine?

Policy, Standardization and guidance of telemedicine qualification management, medical responsibility control: Relevant telemedicine policies include the January 1999, the former Chinese Ministry of Health promulgated the “Notice on Strengthening the Management of Telemedicine Consultation”.

  1. In July 2009, the former Ministry of Health promulgated and implemented the “Administrative Measures on Internet Healthcare Information Services”.
  2. During 2002, 2nd month, the former Ministry of Health promulgated the “2010 Remote Consultation System Project Construction Management Plan”.
  3. In August 2014, the National Health and Family Planning Commission issued the “Opinions on Promoting Telemedicine Services of Medical Institutions”.
  4.  December 2014, the National Health and Family Planning Commission released Notice on Printing and Distributing the Technical Guidelines for the Construction of Telemedicine Information System.
  5. In January 2015, the National Health and Family Planning Commission issued the Notice on Agreeing to Launch the Telemedicine Policy Pilot Project in Five Provinces and Regions of Ningxia and Yunnan.
  6. In April 2018 The General Office of the State Council issued the “Opinions on Promoting the Development of Internet + Medical Health”.
  7.   During 2018 National Health and Health Commission issued “Regulations on the Management of Telemedicine Services (Trial)”

 

What research is going on in Telemedicine?

Telemedicine Research: Telemedicine includes telemedicine consultation, telemedicine education, and establishment of a multimedia health care consultation system. The system of telehealth consultation establishes a new connection between medical experts and patients. This enables patients to receive consultations and treatments from remote experts in situ and in the original hospital. This can save doctors’ and patients’, a lot of time and money.

Telemedicine uses computers, communications, medical technology and equipment to transmit “face-to-face” between experts and patients, experts and medical staff through remote transmission of data, text, voice and image data. Telemedicine is not only a medical or clinical issue. It also includes communication networks, databases, and other issues and needs their integration into the network system.

United’s telemedicine system, which is being put into trial operation, provides a full range of vital signal detection, including heart, blood pressure, and breathing. During the flight, medical support from all over the world is obtainable in time through the mobile communication system. The field telemedicine system developed by the University of Maryland consists of field doctors, communications equipment vehicles, satellite communications networks, field hospitals and medical centers. Each soldier wears a medical bracelet that tests the soldier’s blood pressure and heart rate. There is also a GPS locator which can help the doctor find him quickly when the soldier is injured and get diagnosis and treatment through the telemedicine system.

In China

Some qualified hospitals and medical colleges in China are also carrying out this work. For example, Jinshan Hospital of Shanghai Medical University has published a list of telemedicine consultation experts online. Xi’an Medical University established the “Telemedicine Center” under the aid of the “Asian Bridge” in the United States. It successfully conducted a demonstration of Sino-US telemedicine consultation for US Secretary of State Albright. Recently, the first telemedicine center in Southwest China was established in Guiyang City named as “China Jinwei Guiyang Telemedicine Consultation Center”.

 

Telemedicine can provide good diagnosis and treatment for patients in remote areas and without good medical conditions. These areas are such as rural areas, mountain areas, wilderness survey sites, air, sea, battlefields, etc. It is also possible for medical experts to consult patients at different spatial locations at the same time.

 

What are the main features of Telemedicine?

Main Features of telemedicine are:

  1.  The use of telemedicine in appropriate settings and home health care can greatly reduce the time and cost of transporting patients.
  2.  Can manage and distribute emergency medical services in remote areas well, which is achievable by transmitting photos to key medical centers.
  3.  Can make doctors break through the geographical limits, share the patient’s medical history and diagnostic photos. This is conducive to the development of clinical research.
  4.  It can provide better medical education for medical staff in remote areas.

In general, the vast expansion of telemedicine applications can greatly reduce the barriers for patients to receive medical care. This is because geographical isolation is no longer a medically insurmountable obstacle.

 

What are the basic uses of Tele-medicine?

Basic use of tele medicine: First of all, it was able to make alleviation to the current situation of China’s expert resources and the extremely uneven distribution of China’s population. 80% of China’s population is attributable underdeveloped areas of medical and health resources below the county level. While 80% of China’s medical and health resources are attributable in large and medium-sized cities, and the medical level is unevenly developed. Third-grade hospitals and high-quality, sophisticated medical equipment are also distributed in large cities.

Even in large cities, patients hope to be able to go to tertiary hospitals for specialist treatment, causing patients in primary hospitals to flow into municipal hospitals. This increases the burden on municipal hospitals. The result of this is tight beds, while beds in the grassroots are idle. This eventually leads to uneven and wasteful distribution of medical resources. The use of a remote consultation system allows patients in underdeveloped areas to receive treatment from large hospital specialists. In addition, measures such as distance education can also improve the level of physicians in small and medium hospitals to a certain extent.

Seondly

Secondly, it alleviates the problem of high proportion of referrals in patients in remote areas and high cost. China has a vast territory, a large population, and patients in remote areas. Due to the backwardness of local medical conditions, critically ill and difficult patients are often sent to higher-level hospitals for expert consultation. In this way, transportation expenses, family accompanying expenses and hospitalization medical expenses for visiting a foreign country increase the economic burden on the patient.

At the same time, the bumps on the road also cause much discomfort to the patient’s body. Many patients who did not have access to the large hospitals delay the diagnosis and treatment, causing physical and mental pain to the patients and their families. According to the survey, the proportion of patients in remote areas to higher-level hospitals is quite high. The average cost is very high. Other expenses other than treatment costs (diagnosis costs, various inspection fees, road tolls, accompanying fees, accommodation fees, meals, etc.). It takes thousands of dollars to make the patient almost unable to bear. The remote consultation system allows patients to receive appropriate treatments locally, greatly reducing the cost of visiting.

 

In which fields is Tele medicine Applicable?

Tele medicine apllication field: The goals achievable by telemedicine technology include: Telemedicine diagnostic systems for inspection and diagnosis, telemedicine consultation systems for consultation, telemedicine education systems for teaching and training and family beds.

 

What is Remote bed monitoring system?

The purpose and needs of the application are different. Devices configured in the telehealth system and the communication network environment used are also different. The telemedicine diagnostic system is mainly equipped with various digital medical instruments and corresponding communication interfaces. It mainly runs on the local area network inside the hospital. End user devices include electronic scanners, digital cameras, and microphones, speakers, and the like. The telemedicine education system is similar to the medical consultation system. It mainly uses video conferencing to run on broadband networks. Regardless of the telemedicine system, computers and multimedia devices are essential.

The use of telemedicine is in a wide range of applications, including radiology, case science, dermatology, cardiology, endoscopy and neurology. The application of telemedicine technology is very extensive, so it is obvious that this technology has a huge space for development.

 

Media and Telemedicine

The application of multimedia technology in telemedicine relies on the support of a wide variety of multimedia digital devices. In telemedicine, the main use of multimedia technology is in the following aspects:

(1) Media collection: High resolution images are acquirable with a digital camera (head).

(2) Media storage: Audio, video and medical images need temporary or permanent storage in the computer which is implementable with magnetic or opto-magnetic devices (such as hard disks, floppy disks, optical disks, etc.).

(3) Compression/decompression: The popular JPEG image compression standard can achieve 10:1 to 20:1. The diagnostic results show that it is not damaging to the image.

(4) Image processing: Its basic functions should include angular rotation, horizontal and vertical telescoping, correction of acquisition errors. The ability to observe clear images with the naked eye under clinical conditions.

(5) User interface: The medical interface is the most common because it reflects more medical information (visual information). Thus, the display, keyboard, mouse and window management software are the most basic telemedicine user interface. In addition, multimedia devices are also in need.

 

What is Telemedicine Communication?

(1) Network interface: Different telemedicine entities need different communication environments. The choice of communication network is also diverse, so the network interface rate also has a high and low difference.

(2) Network protocol: The ATM (Asynchronous Transfer Mode) interconnect protocol is widely used in telemedicine systems. H.324 video conferencing protocol is usable to transmit medical images over the telephone network. TCP/IP (Transmission Control Protocol / Internet Protocol) protocol is usable for LAN and WAN interfaces to access medical images and remote medical information sources.

(3) Video transmission: According to different telemedicine needs, the video transmission rate is also different. This is roughly divisible into two types: low-rate and high-rate transmission. The former is usable for video conferencing, and the latter is for diagnostic video transmission. This needs to be HIPAA compliant the standard of which is higher than normal video conferencing services.

(4) Audio transmission: In addition to video, there are audio transmissions in the telemedicine system. It is also divisible into low-rate and high-rate transmission. The use of former is in consultation and the latter is in diagnosis.

(5) Still image (slice) transmission: Usually, the transmission of still images (slices) is one-way communication. The transmission rate is calculated in a single frame, and the traffic is bursty.

(6) Medical records: It is also a one-way transmission. This is mainly text information, so the transmission bandwidth requirements are not high.

(7) Backbone network: As a backbone network for telemedicine, there are many options. But as the network expands, it is necessary to interconnect each LAN into a wide area network through a bridge or router.

 

Medical Benefits of Telemedicine

The use of telemedicine is very wide in rural areas and cities in vast countries like China. It also plays an active role in the treatment of cardiology, brain surgery, psychiatry, ophthalmology, radiology and other medical specialties. The communication technologies usable in telehealth may vary. But the common factors include patients, medical staff, experts and their different forms of medical information signals.

Telemedicine has a strong vitality and is also a need for economic and social development. With the development of information technology, the application of high-tech (such as telemedicine-guided surgery, TV intervention, etc.) and the gradual improvement of various laws and regulations, telemedicine will surely have an unprecedented development opportunity.

 

Development or Advancement of Telemedicine Status

In the late 1950s, American scholar Wittson first used the two-way television system for medical treatment. In the same year, Jutra and others created teleradiology. Since then, the United States has been using communications and electronic technology for medical activities. The word Telemedicine has appeared, and now domestic experts are uniformly translating it as “telemedicine (or tele-medicine).”

What is First Generation Telemedicine?

Telemedicine activities from the early 1960s to the mid-1980s were considered the first generation of telemedicine. Telemedicine development at this stage is slower. From an objective analysis, the information technology at that time was not developed enough. The information superhighway was in a new stage. The amount of information transmission was extremely limited. Also, telemedicine was restricted by communication conditions.

What is Second Generation Telemedicine?

Since the late 1980s, with the continuous improvement of the level of modern communication technology, a large number of valuable projects have launched. Its momentum and influence far exceed the first generation technology which we can regarded as the second generation of telemedicine. From the number of documents included in Medline, the number of documents in telehealth has grown exponentially in the 10 years from 1988 to 1997.

In the implementation of telemedicine systems, the United States and Western European countries are the fastest growing. Great progress is going on mostly through satellite and integrated services data network (ISDN), remote communication, remote consultation, long-distance transmission of medical images, teleconferencing and military medicine.

In 1988, the United States proposed that telemedicine systems should be the concept of an open distributed system. In a broad sense, telemedicine should include modern information technology, especially two-way audiovisual communication technology, computer and remote sensing technology, etc. This is the need in order to deliver medical services to distant patients or for information exchange between doctors.

At the same time, American scholars have defined the concept of telemedicine system as follows:

Scope of Tele-medicine: Telemedicine system refers to a whole, which provides medical services to specific groups of people through communication and computer technology. This system includes remote diagnosis, information service, distance education and other functions. It is based on computer and network communication. It is used for multimedia technology of medical materials to transmit, store, query and display long-distance video and audio information. The Georgia Education Medical System (CSAMS) is the world’s largest and most extensive distance education and telemedicine network for wired, wireless and satellite communication. The Telemedicine Network is part of it.

 

What is  Telehealth Labs?

The Telehealth Labs: Europe and the European Union organized three biomedical engineering laboratories. 10 large companies, 20 pathology laboratories and 120 end-users to participate in large-scale telemedicine system promotion experiments. This promoted the popularity of telemedicine. Australia, South Africa, Japan, Hong Kong and other countries and regions are also carrying out various forms of telemedicine activities.

In December 1988, a strong earthquake struck the former Soviet Union in the Republic of Armenia. With the support of the US-Soviet Space Physiology Joint Working Group, the National Aeronautics and Space Administration of the United States conducted the first international telemedicine. This enabled a hospital in Armenia to communicate with four hospitals in the United States. This shows that telemedicine can cross international political, cultural, social and economic boundaries.

 

Telemedicine Laws and Jurisdical System

Although the telemedicine in the United States started early, its judicial system once prevented the full development of telemedicine. The so-called remote is limited to a certain state. This is because the United States requires medical practice to obtain a medical license in the state, and cross-state practice involves legal issues. According to statistics, in 1993, about 2,250 patients in the United States and Canada visited the telemedicine system, and 1,000 of them were only 3 to 5 minutes of kidney dialysis consultation conducted by a designated doctor in Texas. The average consultation time of the remaining diseases was about 35 minutes.

The US tele-medicine project has a special fund, partly by state and federal funding committees.

Intelligent blood pressure monitor, portable personal medical prevention expert

The staff provides intelligent blood pressure monitor, portable personal medical prevention expert.

In the 1994 fiscal year, at least 13 different federal grant programs allocated $85 million for telemedicine. Georgia alone allocated $8 million to establish telemedicine networks in six regions.

 

What is 3rd Generation Telemedicine?

In 2010, telemedicine began to appear in the community and family, more to the individual, to provide targeted and personalized service development characteristics. According to Qitai.com’s smart home industry report, tele-medicine and smartphone development are closely synchronized. With the development of Internet of Things technology and the popularity of smartphones, tele-medicine also began to integrate with cloud computing and cloud services. Many smart health medical products are gradually becoming available. The advent of remote blood pressure monitors, remote electrocardiographs, and even remote fetal heart monitors has provided the general public users. This has more convenient and intimate daily medical prevention and medical monitoring services. Telemedicine was also able to evolve from disease treatment to disease prevention.

 

Google conducts telemedicine services trial

On October 13, foreign media Recode reported that Google (537.94, 4.73, 0.89%) is quietly entering the increasingly popular telemedicine field. Google’s official Weibo confirmed that it has begun testing telemedicine services, and patients can see through video.

 

Asia and China

China is a country with a vast territory. There are obvious regional differences in medical standards, especially in the vast rural and remote areas. Therefore, telemedicine is more necessary for development in China.

China began to explore telemedicine only since the 1980s. In 1988. Its PLA General Hospital conducted a remote case discussion of neurosurgery through a satellite and a German hospital. In 1995, the Shanghai Education and Research Network and the Shanghai Medical University Remote Consultation Projects were launched. Also, the telemedicine consultation research room was established.

 

The Present

At present, dozens of hospital websites in more than 20 provinces and cities nationwide, including the Chinese Academy of Medical Sciences Peking Union Medical College Hospital and the Chinese Academy of Medical Sciences Fuwai Cardiovascular Hospital, have been qualified and officially put into operation. The patient conducted remote, off-site, real-time and dynamic TV live broadcast consultations. They also successfully carried out the whole process of large-scale international conferences. They also organized dozens of domestic and international lectures, academic exchanges and surgery to greatly promote the development of telemedicine in China.

According to the overall plan of the national health informationization, the Ministry of Health of the General Logistics Department of the People’s Liberation Army put forward the “three major projects” for the informationization construction of the military health system. These were listed as the national “Jinwei Project” military characters 1, 2, and 3, respectively. Among them, the military word No. 2 project is to build a military medical and health information network and a telemedicine consultation system.

The Gap

Although China’s telemedicine has achieved initial results, it still has a large gap from the level of developed countries. Proof is required in terms of technology, policies, regulations and practical applications. At the same time, the masses of the people still need to know about telemedicine. Further improvement is the expectation.

The development of tele-medicine technology is inseparable from the advancement of communication and information technology. China has a vast territory, especially in rural areas and remote areas. The level of medical care is relatively low, and telemedicine is more necessary for development. However, it is still subject to technical, legal and cognitive constraints.

In order to achieve the monitoring of critically ill patients, most hospitals in the early days adopted the means of television monitoring, which is the prototype of tele-medicine. The development of computer technology and communication technology, especially the development of the Internet, provides a technical portal for remote diagnosis, remote treatment and remote surgery. As a result, telemedicine in the modern sense is emerging as a new application technology and is quickly gaining widespread attention.

 

Telemedicine policy pilot in China

The website of the Chinese National Development and Reform Commission issued a notice sometime ago. The National Development and Reform Commission and the National Health and Family Planning Commission decided to agree that the Ningxia Hui Autonomous Region, Guizhou Province and Tibet Autonomous Region should cooperate with the PLA General Hospital, Inner Mongolia Autonomous Region and Peking Union Medical College Hospital, Yunnan Province and China-Japan Friendship Hospital.

Pilot work on telemedicine policy: This notice proposes that all pilot provinces and regions should study and formulate relevant policies, mechanisms, regulations and standards applicable to telemedicine development. This needs to be in terms of operational specifications, liability identification, incentive mechanisms, service charges, and expense reimbursement for telemedicine, and exploring market-oriented Telemedicine service model and operational mechanism.

 

The technology of telemedicine is one of the greatest medical inventions of the 21st century.

 

Tele-medicine refers to the remote diagnosis and treatment of patients through telecommunications channels such as the Internet and mobile platforms. Telemedicine allows patients to interact with doctors from anywhere as long as they have a phone or computer that can connect to the Internet. 

 

What are the Disadvantages of Telemedicine?

Tele-medicine Disadvantages and Criticism: The medical system in the United States is receiving criticism and the cost of medical care is high. Appointing doctors is also a difficult problem, often within a few weeks or even months. The medical costs of patients receiving offline medical treatment are getting heavier and heavier. Hence, the patients hope that the medical industry, like other industries to directly compete with consumers online and have more market competition.

 

The development of Internet medical care cannot ignore legal norms and responsibilities.

 

“In the medical service model, medical care and services are two different concepts. Registration, drug purchase, and referral are part of the service category, which is the content of customer management and should be handled in accordance with the relevant provisions of the contract law. This is because this is in line with civil legal relations.

The most basic principle: The voluntary, fair and equal-price trading activities between equal subjects is the need. Relatively speaking, medical behavior can not be dealt with by ordinary civil legal relations.

 

What can the world learn by looking at the policies and services of the US telemedicine industry?

According to the US Centers for Disease Control and Prevention, there are 1.25 billion outpatient visits per year in the United States. About one-third of outpatients (417 million) are such that telemedicine can solve.

 

According to AHRQ of the US Healthcare Research and Quality Agency, there are approximately 168 million follow-up visits per year in the United States, 80% of which, that is, 134.4 million visits are such that telemedicine services can solve. The two services total a market space of approximately 585 million tele-medicine treatments.

 

In addition, according to statistics from many associations such as the American Cancer Society and the Epilepsy Foundation, there are 5.1 million critically ill patients each year who need to seek expert remote treatment.

 

According to US medical authorities, more than 60% of health service providers and 50% of hospitals in the United States use tele-medicine services to varying degrees. Remote imaging services are available in all states in the United States. Remote mental health services are established in 49 states. Each state has a variety of telehealth consulting services centered on family medicine. According to MedGadget’s estimates, by 2020, the US telemedicine market is poised to reach $6.77 billion, during which the market will grow at a CAGR of 6.3%.

 

So what kind of policies, business models and medical services drive such mature market operations? Let’s take a look together.

 

What kind of policy support does the US tele-medicine have?

  1.                In 1996, the United States Federal State Doctors Association issued the Code of Practice for Interstate Medical Care. This stipulated the definition of interstate behavior, the requirements for medical licenses, the issuance of interstate medical licenses and the preservation of medical records of patients.
  2.              The Balanced Budget Act of 1997 states that doctors who provide telemedicine counseling services to residents in rural areas receive a B compensation for Medicare. This is one of the US’s important insurance bills.
  3.               The Health Insurance and Medical Assistance Benefit Enhancement and Protection Act, promulgated in 2000, clarifies the method, duration, region and type of service for telemedicine compensation.
  4.               Standard Guide for the Correct Use of the Internet in Medical Behavior, promulgated in 2002 clarifies that doctors must comply with the same standard practice of “face-to-face” medical practice for tele-medicine.
  5.              The Patient Safeguards and Affordable Medical Expenses Act, promulgated in 2010, raises the level of assistance and insurance compensation for telemedicine. It converts payment by project to pay for medical value.
Latest US Telehealth Policies after 2010
  1.              In 2011, the US Medicare and Medicaid Service Center issued new telehealth service rules to simplify the eligibility review process for telehealth doctors and the hospital’s telehealth collaboration review process.
  2.              In 2015, the Medical Services Acquisition and Child Health Insurance Program Reauthorization Act was introduced. The factors used in telemedicine and remote patient testing were analyzed around the Act. In addition, hospitals and other medical institutions can apply for a $500,000 grant for medical equipment and technical assistance for telehealth services in rural areas.
  3.               The United States not only enacted legislation at the federal level, but also actively promoted legislation in various states, playing an important role in the interstate development of telehealth. From the February 2017 report from the American Telehealth Association’s “Analysis of the 50-State Telemedicine Gap in the United States”, it can be seen that 13 states in the United States have passed the Telemedicine Act. Some Medicaid programs in 50 states cover certain types of telehealth services, with 11 states providing patients with telehealth services with virtually no barriers.
  4.               In 2017, Teladoc’s Texas State passed the Telemedicine Legislation Act at its 185th Legislative Council, abolishing the requirement that doctors can only provide telehealth services after face-to-face contact with patients. This also provides a good policy environment for Teladoc’s long-term development.
  5.              In November 2017, the US government passed the Veterans E-health and Telemedicine Support Art of 2017 to enable caregivers who got retirement from the military to serve the general public.

These diverse policies from state to regional governments have given birth to a unique business model for US telehealth.

 

Business model of American telemedicine companies

The United States is the most developed country in the Internet and has built the world’s most developed medical network. The telemedicine service in the United States is based on the widely-covered Internet technology. With the university as the core to provide technical support for tele-health development, the integration of regional medical resources as the core of management. It is increasingly improving its payment mechanism to ensure the rapid development of tele-health services.

 

AMD Global Telemedicine lists three possible service models that telehealth services can choose from:

  1.                Access the care model: This model provides care for those who are in remote areas or who are unable to provide care for them due to limited geography or resources.
  2.              Cost savings model: The goal of this model is to reduce costs by reducing the cost of going to and from the hospital and the cost of attending a clinic.
  3.               Market model: This model can extend the market covered by healthcare providers and provide services and expertise at greater distances. But this model relies heavily on policy support.

 

The Telemedicine Magazine defines three unconventional but successful telemedicine business models:

  1.  Model between agencies: An expert doctor at a hospital can provide their expertise to their local hospital or assist them in making a diagnosis. The medical center can contract with rural hospitals or other institutions that require on-demand expertise to be billed monthly or on a per-time basis.
  2.  Responsible care agency providing emedicine services: e-medicine technology companies and startups can provide services to ACO to improve the quality of care and reduce costs. ACOs that meet certain conditions of care will receive Medicare awards.
  3.  Serve corporate employees: Telehealth providers can provide telehealth-based care to employers’ employees through a combination of on-site kiosks and online applications.

 

To develop a telehealth program, companies must define a business model that is economically sustainable and can successfully meet challenges. There is no one-size-fits-all approach in this area. The companies must tailor their products to meet the needs of the community or market segments as well as state and federal legal requirements.

 

What kind of services does US telemedicine provide?

The purpose of developing emedicine in China is to optimize the allocation of medical resources, and establish e-medicine facilities in grassroots hospitals. This is so that people in remote areas can enjoy the services of the top three hospitals through video. Also, the incorporation of the remote video teaching is possible within the scope of e-medicine.

 

Unlike other countries’ telemedicine development, e-medicine companies in the United States mostly provide routine disease counseling and chronic disease daily care services. In this mode, the cost of tele-medicine providers is very low and can rely on as a physical hospital. For example, if an asthma patient receives a doctor’s drug recommendation in the video, he or she can go directly to the pharmacy to download the corresponding prescription and take the medicine.

 

The tele medicine’s routine services typically consist of two to three steps, such as a seasonal allergy visit:

               Ask the patient some simple questions about allergic symptoms.

  1.               The blood panel is ordered by the doctor, and the patient can draw blood locally.
  2.               Visit the doctor to check the results and the doctor will give follow-up advice.

 

The service steps for asthma are:
  1.                Video chat with the doctor, the patient tells the doctor about asthma symptoms.
  2.               The doctor advises the patient and issues the medication requirement.
  3.               The patient can get a prescription at the local pharmacy and give feedback to the doctor about the condition after taking the drug.

 

Service steps for chronic diseases such as high blood pressure are:
  1.  Video chat with the doctor and provide blood pressure information and drug use information to the doctor.
  2.  The doctor can prescribe a prescription for the patient, or recommend a new drug based on the patient’s condition. He can also give the patient a non-pharmaceutical recommendation to lower the blood pressure.
  3.  The patient can take the prescription to the pharmacy to take the medicine and continue to respond to the doctor’s use of the drug.

 

Distribution and Introduction of American telemedicine companies

Among the 22 largest telemedicine companies in the United States, there are 9 companies in California, 3 companies in Virginia and Texas. There are 2 companies in Florida, Oregon and Minneapolis. There is one company in Pennsylvania, Arizona, Massachusetts and New York.

 

M & A status of telemedicine enterprises

Under the huge market, many tele-medicine companies are constantly innovating and through the mergers and acquisitions. They are adopting acquisitions and other means to check their own business blind spots. There are also relevant practitioners in the medical field to enter the industry through the acquisition of telehealth enterprises.

 

China’s Telemedicine related Policies

Since 2009, in order to improve the lack of grassroots pathology and medical care, the new medical reform policy was intensively published. The policy guidance was issued from multiple angles. At the same time, in the process of issuing documents, we are also discovering some of the problems encountered in the development of pathological remote diagnosis problems:

 

I. About tele medicine

The National Health and Family Planning Commission has issued nine policy opinions or program plans such as the “Opinions on Promoting Tele medicine Services in Medical Institutions”.

The biggest drawback of tele medicine pathology is that front-end standardization cannot find a solution.

 

II. About graded treatment

The General Office of the State Council promulgated the “Guiding Opinions on Promoting the Construction of Graded Diagnosis and Treatment System”. It is requiring the first-level consultation, two-way referral, rapid division and treatment, and a new medical order. Pathology medicine conforms to the needs of graded diagnosis and treatment, and extends from top to bottom. Primary hospitals need their equipment with pathology or pathological diagnosis resources.

 

III. About doctors practice more

The National Health and Family Planning Commission promulgated new policies such as the “Administrative Measures for the Registration of Physicians”. The liberalization of doctors’ practice can solve the needs of clinicians in primary hospitals. But the pathological diagnosis is special, especially the need for rapid pathological diagnosis. But it is difficult to practice more.

 

IV. About third-party independent diagnostic center

The National Health and Family Planning Commission issued nearly ten articles including the “Notice on Printing the Basic Standards and Management Regulations of the Pathological Diagnosis Center (Trial)”. It proposes to encourage the establishment of independent pathological diagnostic institutions to promote the sharing of regional pathological medical resources, promote graded diagnosis and treatment, and encourage pathology. The diagnostic center establishes a collaborative relationship with other medical institutions. Under the premise of ensuring biosafety and diagnostic quality, the pathological diagnosis center provides pathological diagnosis services for other medical institutions.

 

The third-party pathological independent diagnosis center can share the wisdom of pathologists through information means. The establishment of pathological diagnosis center is independently in each region, and all areas have irradiation. Further, the application of digital pathological diagnosis equipment can promote the connection between the third-party pathological diagnosis center and hospitals of all levels. However, surgery that requires rapid pathology is still difficult to carry out through third parties.

 

V. About medical association (medical group)

The National Health and Family Planning Commission issued a document requesting the construction of a “1+X” medical association. This was for vertically integrating medical resources and forming a management model for sharing pathological resources and division of labor.

 

VI. About Internet Hospital

 The National Health and Family Planning Commission issued the “Regulations on the Administration of Internet Diagnosis and Treatment (Trial)”, requiring that “medical institutions conducting Internet diagnosis and treatment activities should comply with the relevant provisions of graded diagnosis and treatment. It should also be compatible with their functional tasks.” The opinion stipulates that Internet hospitals or pathological diagnostic institutions must have medical care. The organization’s practice license, the application of standardized pre-processing digital pathology intelligent diagnostic equipment can solve security problems.

 

China’s Tele-medicine Development

China started late in the field of tele medicine, mainly because of the uneven distribution of medical resources in China. The lack of medical level of grassroots doctors, and the disorder of patients, which is not conducive to the development of telemedicine industry.

 

It was not until the end of the 1980s that China began research on exploratory telemedicine experiments. In the mid-1990s, the construction and application of practical telemedicine systems began.

However, after entering the 21st century, the application of tele-medicine construction in China has developed rapidly.

Supporting the development of telemedicine has many benefits for China. For example, telemedicine breaks the regional restrictions. It has made up for the shortage of medical resources in remote areas. It has further improved and improved the medical service level in big cities. Also, it greatly promoted the development of medical and health care. For another example, tele-medicine is changing the relationship between traditional medical service providers and patients. It is promoting the escalation of competition among some important medical institutions. This is conducive to the improvement of the overall medical level.

 

Therefore, in recent years, China is beginning to increase support for tele-medicine. In February 2015, the National Development and Reform Commission agreed that Ningxia Autonomous Region, Guizhou Province. And Tibet Autonomous Region will cooperate with the PLA General Hospital, Inner Mongolia Autonomous Region and Peking Union Medical College Hospital and Yunnan Province and China-Japan Friendship Hospital to carry out telemedicine policy pilot work.

 

Chinese National Tele-medicine Collaborative Portal Launch Ceremony

With the influence of national policies, the scale of China’s telecare market has grown significantly. In 2016, the market size of telecare (including remote patient monitoring, video conferencing, online consultation, personal medical care devices, wireless access electronic cases and prescriptions) reached 6.15 billion yuan, a year-on-year increase of 51%.

 

Analysis of the Future Trend of China’s Tele medicine Industry

First, the telecare industry has grown in size. On the one hand, China’s aging population is increasing. The number of chronic patients is growing rapidly and the treatment time is long. The demand for services is large, stimulating the market demand for the telecare work market. On the other hand, the popularity of mobile medical terminals, development of medical Internet of Things and the increased participation of medical institutions will also promote the continuing expansion of telecare scale. Forward-looking Industrial Research Institute estimates that the market size of the domestic tele-care industry in 2023 will exceed 23 billion yuan.

 

Forecast of market size of domestic tele medicine industry in 2018-2023 (unit: 100 million yuan)

 Source: Prospective Industry Research Institute

 

Second, there is expectation that the medical reimbursement ratio will increase steadily. Although inadequate medical reimbursement is always considerable to be a major obstacle to telemedicine implementation. Current changes are driving the expansion of tele medicine. In the future, more medical insurance institutions and medical insurance advantages will show up in the coverage of tele-medicine services.

 Increment in Services

Third, tele-medicine services are increasing. Mature tele-0medicine services can include chronic counseling such as psychological counseling, supplementary prescription drugs, diabetes, chronic obstructive pulmonary disease and congestive heart failure. It can also include data transmission and storage such as image data, and obtain second consultation advice. It can also include emergency, trauma, stroke, intensive care and other remote two-way video guidance treatment.

 

Fourth, the technical level of telecare services is increasing significantly. The next-generation telecare system will integrate various information systems, network technologies, medical imaging equipment and traditional medical systems to evolve into a new generation of integrated telecare systems. In the new generation of integrated telehealth systems, telehealth will become a new medical system model in the network information environment. It will also further develop a more effective patient health-centered diversified telehealth service, providing good inspiration.

 

 Entrepreneurial Outlets

Finally, there will be more entrepreneurial outlets in the telemedicine field. In the future, based on the promising prospects of the industry, more entrepreneurial projects will be favored by VCs. Among them, with the reform of the medical system, online drug sales are about to break. Also, the number of pharmaceutical import companies will increase significantly. As more doctors participate in the tele medicine process, there will be a significant increase in the number of doctor-type and health management monitoring and consulting companies.

 

Seeking progress in eHealth from differences

The mature medical insurance system in the United States, the uniform distribution of hospitals and the limitation of video streaming have limited the development of telemedicine to a certain extent. But the cumbersome appointment procedures and the cost of distance promote the development of telehealth.

 

The most valuable part of development is the management of chronic diseases under telehealth. After fully understanding the patient’s physical condition. The doctor passes the real-time data to the doctor with the help of various types of testing instruments. In this case, the doctor can directly understand the patient’s physical and emotional changes through video, and give advice on the next period of care. The accuracy of care recommendations under these conditions is high. The time and cost of patients traveling to and from the hospital are eliminated, especially for patients with limited mobility.

 

Domestic Internet medical care is not the same as that of the United States. It is difficult to reach the US tele-medicine level in the short term. The reason is that most of the US tele-medicine companies cooperate with commercial insurance companies. Also, a large part of their profits come from commercial insurance companies. Domestic commercial medical insurance is still in the early stage of development, and residents’ insurance is also dependent on national medical insurance.

 

Restricted income is difficult to promote service upgrades. Therefore, other countries cannot copy this model of the United States directly at home. Of course, all don’t have to completely follow the US Internet medical development model. However, if there are merits, others can still reflect on themselves and choose the best.

 Chinese Comparision

Since its establishment in 2003, Nanjing Fuyi Technology Development Co., Ltd. is committed to pathological telemedicine services for 15 years. The wisdom pathology cloud portal provided by Fuyi will share the standardized pre-processing equipment, digital pathology intelligent diagnostic equipment and online pathological pathological resources from the upper-level hospitals to the lower-level hospitals through the medical joint mode. By training the actual operators of the primary hospitals, the technicians learn to draw materials. Further features are:

  • Production
  • Remote transmission of pathological resources are possible by remote transmission
  • To solve the problem of multi-point practice of pathologists by remote means
  • To solve the problem of different quality of pathological specimens through standardized pre-treatment methods. The medical Cooperate to build a pathological cloud platform.
  • Establish a central cloud room, cloud pathology department
  • To realize the construction of a three-level framework for pathological diagnosis.

 

Telemedicine Portal in India, Asia

The condition of telemedicine or telehealth is not clear in India. However, entrepreneurs are making efforts to the maximum. The only worthy telehealth platform in India is VVFIT which is also in the process of becoming the world’s largest health IoT and international telehealth platform. It also facilitates eOPD and medical tourism. There was a VLE (Village Level Entrepreneurs) program where the patients use to reach VLE centres for communicating with the doctor. Though the name suggests village level but it was both country and civic. However, it can not find many takers due to lousy government departments activity and corruption. This was also not full fledged as the services are not available from any place of own choice but the patient has to reach specified VLE centres.

 

What is the difference between Telemedicine and Telehealth?

Generally, telemedicine and telehealth are in use interchangeably for each other but they definitely have different meanings. According to the leading tele medicine market operator VVFIT.COM telemedicine refers to remote OPD or eOPD i.e. interaction with the doctor. While telehealth is its superset, such that, it also entails overall remote health technology like on site appointment booking, hospital management, medical records maintenance, medical devices remote control and operation, pathological industry automation and so on. It is telehealth that can further attribute the facilities of medical IoT or Health IoT to telemedicine.

 

Can Telehealth and Medical Tourism go hand in hand?

A question arises will telemedicine decrease medical tourism? The answer is that tele health or telemedicine will definitely increase medical tourism. This might be against the expectation of the pessimists but with telehealth development more people will take remote services. Hence, more remote activities will take place which will call for live interaction also. Apart from OPD there will of course be need to travel, thereby facilitating medical tourism. This is real life approach as real life is always optimistic and the entire environment is always conducive of progression rather than regression. Just as with automation, computerization and AI jobs will always increase as overall number and scope of activities will also increase.

 

Conclusion

Is telemedicine boon or curse?

Telemedicine will facilitate even more health services than ever and will enhance health and healthcare market with the aid of health tech. This will give rise in employment, income and facilitation of services to the clients of the medical and health sector industries. The only threat of telemedicine is on pessimists which will prove their idea of curse as only a figment of the imagination.

 

See also:

 

 

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