View source for Telehealth

{{Short description|Health care by telecommunication}}
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{{More sources needed|date=January 2025}}
[[File:Doctor attending by teleconsultation.jpg|thumb|Telehealth]]
'''Telehealth''' is the distribution of [[Health care|health-related services]] and information via electronic information and [[telecommunications|telecommunication technologies]].<ref name="Office for the Advancement of Telehealth-2022">{{Cite web |last=<!-- no author attribution --> |date=March 2022 |title=What is TeleHealth? |url=https://www.hrsa.gov/telehealth/what-is-telehealth |access-date=12 January 2024 |website=Office for the Advancement of Telehealth |publisher=The Health Resources and Services Administration}}</ref> It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions.<ref name="Shaw-2009">{{cite journal | vauthors = Shaw DK | title = Overview of telehealth and its application to cardiopulmonary physical therapy | journal = Cardiopulmonary Physical Therapy Journal | volume = 20 | issue = 2 | pages = 13–8 | date = June 2009 | pmid = 20467533 | pmc = 2845264 | doi = 10.1097/01823246-200920020-00003 }}</ref><ref name="CFP"/>

'''Telemedicine''' is sometimes used as a [[synonym]], or in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. When rural settings, lack of transport, a lack of mobility, conditions due to outbreaks, epidemics or pandemics, decreased funding, or a lack of staff restrict access to care, telehealth may bridge the gap<ref>{{cite journal | vauthors = Mashima PA, Doarn CR | title = Overview of telehealth activities in speech-language pathology | journal = Telemedicine Journal and e-Health | volume = 14 | issue = 10 | pages = 1101–17 | date = December 2008 | pmid = 19119834 | doi = 10.1089/tmj.2008.0080 }}</ref> and can even improve retention in treatment<ref>{{cite journal |last1=Lynch |first1=Joshua J. |last2=Payne |first2=Emily R. |last3=Varughese |first3=Renoj |last4=Kirk |first4=Hilary M. |last5=Kruger |first5=Daniel J. |last6=Clemency |first6=Brian |title=Comparison of 30-day retention in treatment among patients referred to opioid use disorder treatment from emergency department and telemedicine settings |journal=Journal of Substance Use and Addiction Treatment |date=October 2024 |volume=165 |article-number=209446 |doi=10.1016/j.josat.2024.209446 |pmid=38950782 }}</ref> as well as provide distance-learning; meetings, supervision, and presentations between practitioners; online information and [[health data]] management and healthcare system integration.<ref name="Miller-2007">{{cite journal | vauthors = Miller EA | title = Solving the disjuncture between research and practice: telehealth trends in the 21st century | journal = Health Policy | volume = 82 | issue = 2 | pages = 133–41 | date = July 2007 | pmid = 17046097 | doi = 10.1016/j.healthpol.2006.09.011 }}</ref> Telehealth could include two [[clinician]]s discussing a case over [[Videoconferencing|video conference]]; a robotic surgery occurring through remote access; physical therapy done via digital monitoring instruments, live feed and application combinations; tests being forwarded between facilities for interpretation by a higher specialist; home monitoring through continuous sending of patient health data; client to practitioner online conference; or even videophone interpretation during a consult.<ref name="Office for the Advancement of Telehealth-2022" /><ref name="Shaw-2009" /><ref name="Miller-2007" /><ref>{{cite journal |last1=Barbosa |first1=William |last2=Zhou |first2=Kina |last3=Waddell |first3=Emma |last4=Myers |first4=Taylor |last5=Dorsey |first5=E. Ray |title=Improving Access to Care: Telemedicine Across Medical Domains |journal=[[Annual Review of Public Health]] |date=2021 |volume=42 |pages=463–481 |doi=10.1146/annurev-publhealth-090519-093711 |doi-access=free}}</ref>

== Telehealth versus telemedicine ==
Telehealth is sometimes discussed interchangeably with telemedicine, the latter being more common than the former. The [[Health Resources and Services Administration]] distinguishes telehealth from telemedicine in its scope, defining telemedicine only as describing remote clinical services, such as diagnosis and monitoring, while telehealth includes [[Preventive healthcare|preventative]], promotive, and curative care delivery.<ref name="Office for the Advancement of Telehealth-2022" /> This includes the above-mentioned non-clinical applications, like administration and provider education.<ref name="Shaw-2009" /><ref name="CFP"/>

The [[United States Department of Health and Human Services]] states that the term telehealth includes "non-clinical services, such as provider training, administrative meetings, and continuing medical education", and that the term telemedicine means "remote clinical services".<ref name="Tss5ihId">{{cite web |url=http://americasmarkets.usatoday.com/2015/07/01/teladoc-shares-surge-more-than-50-in-healthy-ipo-debut/ |title=Teladoc shares surge 50% in healthy IPO debut |access-date=2015-07-02 |date=2015-07-01 |work=[[USA Today]] | vauthors = Mitchell B }}</ref>
The [[World Health Organization]] uses telemedicine to describe all aspects of health care including preventive care.<ref name="who">{{cite book |title=Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth |date=2010 |publisher=World Health Organization |isbn=978-92-4-156414-4 |hdl=10665/44497 |hdl-access=free }}{{pn|date=July 2025}}</ref> The [[American Telemedicine Association]] uses the terms telemedicine and telehealth interchangeably, although it acknowledges that telehealth is sometimes used more broadly for remote health not involving active clinical treatments.<ref name="ATA">{{cite web|url=http://www.americantelemed.org/learn/what-is-telemedicine|title=What is Telemedicine?|publisher=American Telemedicine Association|location=Washington, D.C.|archive-url=https://web.archive.org/web/20130508215350/http://www.americantelemed.org/learn/what-is-telemedicine|archive-date=8 May 2013|access-date=21 August 2011}}</ref>

[[eHealth]] is another related term, used particularly in the U.K. and Europe, as an umbrella term that includes telehealth, [[electronic medical record]]s, and other components of [[health information technology]].<ref>{{cite journal |last1=Della Mea |first1=Vincenzo |title=What is e-Health (2): The death of telemedicine? |journal=Journal of Medical Internet Research |date=22 June 2001 |volume=3 |issue=2 |article-number=e22 |doi=10.2196/jmir.3.2.e22 |doi-access=free |pmid=11720964 |pmc=1761900 }}</ref>

== Methods and modalities ==
{{Further|List of video telecommunication services and product brands}}
Telehealth requires good Internet access by participants, usually in the form of a strong, reliable [[broadband]] connection, and broadband mobile communication technology of at least the fourth generation (4G) or long-term evolution (LTE) standard to overcome issues with video stability and bandwidth restrictions.<ref name="pmid32224764">{{cite journal | vauthors = Alexandrov AW, Alexandrov AV | title = Innovations in Prehospital Stroke Management Utilizing Mobile Stroke Units | journal = Continuum | location = Minneapolis, Minn. | volume = 26 | issue = 2 | pages = 506–512 | date = April 2020 | pmid = 32224764 | doi = 10.1212/CON.0000000000000850 }}</ref><ref name="pmid26641366">{{cite journal | vauthors = Itrat A, Taqui A, Cerejo R, Briggs F, Cho SM, Organek N, Reimer AP, Winners S, Rasmussen P, Hussain MS, Uchino K | title = Telemedicine in Prehospital Stroke Evaluation and Thrombolysis: Taking Stroke Treatment to the Doorstep | journal = JAMA Neurology | volume = 73 | issue = 2 | pages = 162–8 | date = February 2016 | pmid = 26641366 | doi = 10.1001/jamaneurol.2015.3849 | doi-access = free }}</ref><ref name="pmid28872449">{{cite journal | vauthors = Audebert H, Fassbender K, Hussain MS, Ebinger M, Turc G, Uchino K, Davis S, Alexandrov A, Grotta J | collaboration = PRESTO Group | title = The PRE-hospital Stroke Treatment Organization | journal = International Journal of Stroke| volume = 12 | issue = 9 | pages = 932–940 | date = December 2017 | pmid = 28872449 | doi = 10.1177/1747493017729268 | doi-access = free }}</ref> As broadband infrastructure has improved, telehealth usage has become more widely feasible.<ref name="Office for the Advancement of Telehealth-2022" /><ref name="Shaw-2009" />

[[Health professional|Healthcare providers]] often begin telehealth with a [[needs assessment]] which assesses hardships that can be improved by telehealth such as travel time, costs or time off work.<ref name="Office for the Advancement of Telehealth-2022" /><ref name="Shaw-2009" /> Collaborators such as [[Technology company|technology companies]] can ease the transition.<ref name="Office for the Advancement of Telehealth-2022" />

Delivery can come within four distinct domains: [[Live video streaming|live video (synchronous)]], [[Store and forward|store-and-forward (asynchronous)]], [[remote patient monitoring]], and [[MHealth|mobile health]].<ref name="The Center for Connected Health Policy" /> Audio-based telemedicine, primarily through telephone consultations, has been studied as a tool for managing chronic conditions. A systematic review of 40 randomized controlled trials found that audio-based care was generally comparable to in-person or video care, though with low to very low certainty of evidence.<ref>{{Cite journal |last1=Albritton |first1=Jordan A. |last2=Booth |first2=Graham |last3=Kugley |first3=Shannon |last4=Reddy |first4=Shivani |last5=Coker-Schwimmer |first5=Manny |last6=Fujita |first6=Miku |last7=Crotty |first7=Karen |date=2025 |title=Audio-Based Care for Managing Chronic Conditions in Adults: A Systematic Review |journal=Medical Care |volume=63 |issue=2 |pages=164–182 |doi=10.1097/MLR.0000000000002097 |pmc=11708983 |pmid=39791849}}</ref>

=== Store and forward ===
[[Store and forward|Store-and-forward]] telemedicine involves acquiring medical data (like [[Medical imaging|medical images]], [[biosignal]]s etc.) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment [[offline]].<ref name="ATA"/> It does not require the presence of both parties at the same time.<ref name="Sachpazidis">{{cite thesis|url=https://www.consultingradiologists.com/wp-content/uploads/2018/08/Dissertation-final-10Nov2008.pdf|title=Image and Medical Data Communication Protocols for Telemedicine and Teleradiology (dissertation)|publisher=Department of Computer Science, Technical University of Darmstadt|location=Darmstadt, Germany|date=10 Jul 2008 | vauthors = Sachpazidis I |access-date=14 Aug 2018}}</ref> [[Dermatology]] (cf: [[teledermatology]]), [[radiology]], and [[pathology]] are common specialties that are conducive to asynchronous telemedicine. A properly structured [[medical record]], preferably in [[Electronic medical record|electronic]] form, should be a component of this transfer. The 'store-and-forward' process requires the clinician to rely on a history report and audio/video information in lieu of a physical examination.<ref name="ATA"/>

=== Remote monitoring ===
[[File:Beurer BM26 sphygmomanometer.jpg|thumb|A blood pressure monitor]]
[[Remote patient monitoring|Remote monitoring]], also known as self-monitoring or testing, enables medical professionals to monitor a patient remotely using various technological devices. This method is primarily used for managing chronic diseases or specific conditions, such as heart disease, diabetes mellitus, or asthma. These services can provide comparable health outcomes to traditional in-person patient encounters, supply greater satisfaction to patients, and may be cost-effective.<ref>{{cite journal | vauthors = Salehahmadi Z, Hajialiasghari F | title = Telemedicine in iran: chances and challenges | journal = World Journal of Plastic Surgery | volume = 2 | issue = 1 | pages = 18–25 | date = January 2013 | pmid = 25489500 | pmc = 4238336 }}</ref> Examples include home-based nocturnal [[Kidney dialysis|dialysis]],<ref name="pmid10569098">{{cite journal | vauthors = Pierratos A | title = Nocturnal hemodialysis: dialysis for the new millennium | journal = Canadian Medical Association Journal | volume = 161 | issue = 9 | page = 1137 | date = November 1999 | pmid = 10569098 | pmc = 1230743 }}</ref> improved joint management,<ref>{{cite journal | vauthors = Koutras C, Bitsaki M, Koutras G, Nikolaou C, Heep H | title = Socioeconomic impact of e-Health services in major joint replacement: A scoping review | journal = Technology and Health Care | volume = 23 | issue = 6 | pages = 809–17 | date = 17 August 2015 | pmid = 26409523 | doi = 10.3233/THC-151036 }}</ref> and diabetes care using audio-based telemedicine with remote monitoring tools.<ref>{{cite journal |last1=Reddy |first1=Shivani |last2=Booth |first2=Graham |last3=Coker-Schwimmer |first3=Manny |last4=Kugley |first4=Shannon |last5=Rodriguez-Borja |first5=Ivette |last6=Patel |first6=Sheila V. |last7=Fujita |first7=Miku |last8=Philbrick |first8=Sarah |last9=Ruwala |first9=Richa |last10=Albritton |first10=Jordan A. |last11=Crotty |first11=Karen |title=Audio-Based Care for Managing Diabetes in Adults: A Systematic Review |journal=Medical Care |date=February 2025 |volume=63 |issue=2 |pages=152–163 |doi=10.1097/MLR.0000000000002096 |pmc=11708993 |pmid=39791848 }}</ref>

=== Real-time interactive ===
[[Electronic consultation]]s are possible through interactive telemedicine services which provide real-time interactions between patient and provider.<ref name="Sachpazidis" /> [[Videotelephony|Videoconferencing]] has been used in a wide range of clinical disciplines and settings for various purposes, including management, diagnosis, counseling, and monitoring of patients.<ref>{{cite journal | vauthors = Fatehi F, Armfield NR, Dimitrijevic M, Gray LC | title = Clinical applications of videoconferencing: a scoping review of the literature for the period 2002-2012 | journal = Journal of Telemedicine and Telecare | volume = 20 | issue = 7 | pages = 377–83 | date = October 2014 | pmid = 25399998 | doi = 10.1177/1357633X14552385 }}</ref>

=== Videotelephony ===
{{main|Videotelephony}}
Videotelephony comprises the technologies for the reception and transmission of audio-video signals by users at different locations for communication between people in real time.<ref name=McGrawHill>McGraw-Hill Concise Encyclopedia of Engineering. [http://encyclopedia2.thefreedictionary.com/Videotelephony Videotelephony], McGraw-Hill, 2002. Retrieved from the FreeDictionary.com website, January 9, 2010</ref>

At the dawn of the technology, videotelephony also included ''image phones'' which would exchange still images between units every few seconds over conventional [[Plain old telephone service|POTS]]-type telephone lines, essentially the same as [[Slow-scan television|slow scan TV]] systems.{{Citation needed|date=January 2025}}

Currently, videotelephony is particularly useful to the [[deaf]] and [[Speech disorder|speech-impaired]] who can use it with [[sign language]] and also with a [[Video Relay Service|video relay service]], as well as to those with [[disability|mobility issues]] or those who are located in distant places and are in need of [[telerehabilitation|telemedical]] or [[distance education|tele-educational]] services.<ref>{{Cite web |date=2022-07-18 |title=Video Relay Services {{!}} Federal Communications Commission |url=https://www.fcc.gov/consumers/guides/video-relay-services?utm_source=chatgpt.com |access-date=2025-04-18 |website=www.fcc.gov |language=en}}</ref><ref>{{Cite web |title=NAD - National Association of the Deaf |url=https://www.nad.org/resources/technology/telephone-and-relay-services/video-relay-services/ |access-date=2025-04-18 |website=www.nad.org}}</ref>

==Categories==
=== Emergency care ===
[[File:US Navy 060518-N-2832L-013 Senior training specialist with Multi-Services Group International (MSGI), Michael Bedwell, trains Sailors to use Battlefield Medical Information Systems Telemedicine (BMIST) equipped Personal Digital.jpg|thumb|U.S. Navy medical staff being trained in the use of handheld telemedical devices (2006)]]
Common daily emergency telemedicine is performed by SAMU Regulator Physicians in [[France]], [[Spain]], [[Chile]], and [[Brazil]]. [[Aircraft]] and [[Maritime transport|maritime]] emergencies are also handled by SAMU centres in Paris, Lisbon and Toulouse.<ref>George R. Schwartz, C. Gene Cayten; George R. Schwartz (editor). [https://books.google.com/books?id=NlZ_aST4_hcC Principles and Practice of Emergency Medicine, Volume 2], Lea & Febiger, 1992, pg.3202, {{ISBN|0-8121-1373-X}}, {{ISBN|978-0-8121-1373-0}}.</ref>

A recent study identified three major barriers to the adoption of telemedicine in emergency and critical care units. They include:
* Regulatory challenges related to the difficulty and cost of obtaining licensure across multiple states, malpractice protection and privileges at multiple facilities
* Financial barriers including a lack of acceptance and reimbursement by government payers and some commercial insurance carriers, which places the investment burden squarely upon the hospital or healthcare system.
* Cultural barriers occurring from the lack of desire, or unwillingness, of some physicians to adapt clinical paradigms for telemedicine applications.<ref>{{cite journal | vauthors = Rogove HJ, McArthur D, Demaerschalk BM, Vespa PM | title = Barriers to telemedicine: survey of current users in acute care units | journal = Telemedicine Journal and e-Health | volume = 18 | issue = 1 | pages = 48–53 | date = January–February 2012 | pmid = 22082107 | doi = 10.1089/tmj.2011.0071 }}</ref>
[[File:Операционная. ФЦН (Тюмень) 01.JPG|thumb|Telemedicine system. ''[[Federal Center of Neurosurgery (Tyumen)|Federal Center of Neurosurgery in Tyumen]]'' (2013)]]

Emergency telehealth is also gaining acceptance in the [[United States]]. There are several modalities currently being practiced that include but are not limited to TeleTriage, TeleMSE, and ePPE.

An example of telehealth in the field is when EMS arrives on scene of an incident and is able to take an [[Electrocardiography|EKG]] that is then sent directly to a physician at the hospital to be read, allowing for instant care and management.<ref>{{cite journal | vauthors = Langabeer JR, Champagne-Langabeer T, Alqusairi D, Kim J, Jackson A, Persse D, Gonzalez M | title = Cost-benefit analysis of telehealth in pre-hospital care | journal = Journal of Telemedicine and Telecare | volume = 23 | issue = 8 | pages = 747–751 | date = September 2017 | pmid = 27913657 | doi = 10.1177/1357633X16680541 | doi-access = free }}</ref>

=== Telenursing ===
{{main|Telenursing}}
[[File:Telehealth Teleiechyd - Welsh Government video; 2016.webm|thumb|A short video on telenursing by the [[Welsh Government]] (2016)]]
Telenursing refers to the use of [[telecommunications]] and [[information technology]] in order to provide [[nursing]] services in health care whenever a large physical distance exists between patient and nurse, or between any number of nurses. As a field, it is part of telehealth, and has many points of contact with other medical and non-medical applications, such as [[telediagnosis]], teleconsultation, telemonitoring, etc.

Telenursing is achieving significant growth rates in many countries due to several factors: the preoccupation with reducing the costs of health care, an increase in the [[aging]] and chronically ill population, and the increase in coverage of health care to distant, rural, small or sparsely populated regions. Among its benefits, telenursing may help solve increasing shortages of nurses, reduce distances and travel time, and keep patients out of hospital. A greater degree of job satisfaction has been registered among telenurses.<ref>{{cite web | url = http://www.e-health-insider.com/news/item.cfm?ID=1263 | archive-url = https://web.archive.org/web/20060618103208/http://www.e-health-insider.com/news/item.cfm?ID=1263 | archive-date = 18 June 2006 | title = Nurses Happier Using Telecare, Says International Survey | publisher = eHealth Insider | date = 15 June 2005 | access-date = 4 April 2009 }}</ref>

In [[Australia]], during January 2014, [[Melbourne]] tech startup [[Small World Social]] collaborated with the [[Australian Breastfeeding Association]] to create the first hands-free breastfeeding [[Google Glass]] application for new mothers.<ref name="Lactation Help">{{cite web|title=Google Glass connects breastfeeding moms with lactation help|url=http://www.inquisitr.com/1224638/google-glass-connects-breastfeeding-moms-with-lactation-help/|website=Inquisitr|date=24 April 2014 |access-date=12 June 2014}}</ref> The application, named [[Google Glass Breastfeeding app trial]], allows mothers to nurse their baby while viewing instructions about common breastfeeding issues (latching on, posture, etc.) or call a lactation consultant via a secure Google Hangout,<ref>{{cite web|url=https://vimeo.com/87625169|title=Breastfeeding Walkthrough for Mothers and Counselors|first=Small World|last=Social|date=25 February 2014|via=Vimeo}}</ref> who can view the issue through the mother's Google Glass camera.<ref name="Jumpin Today Show">{{cite web|title=Exclusive Clips Google glasses help breastfeeding mums|url=http://www.jump-in.com.au/show/today/videos/3496995149001/|website=Jumpin Today Show|publisher=Mi9 Pty. Ltd.|access-date=12 June 2014|archive-date=11 July 2014|archive-url=https://web.archive.org/web/20140711191133/http://www.jump-in.com.au/show/today/videos/3496995149001/}}</ref> The trial was successfully concluded in [[Melbourne]] in April 2014, and 100% of participants were breastfeeding confidently.<ref>{{cite news| url=http://www.smh.com.au/technology/technology-news/breastfeeding-mothers-get-help-from-google-glass-and-small-world-20140118-311s3.html | work=The Sydney Morning Herald | title=Breastfeeding mothers get help from Google Glass and Small World}}</ref><ref name="Google Glass">{{cite web|title=Turns Out Google Glass Is Good for Breastfeeding|url=https://www.vice.com/en/article/turns-out-google-glass-is-good-for-breastfeeding/|publisher=Motherboard Vice Media Inc.|access-date=1 May 2014|date=21 April 2014}}</ref><ref>{{cite web|url=http://www.smallworldsocial.com/|title=SWS Website - We transfer complex and tacit knowledge|website=SWS Website}}</ref><ref>{{cite web|url=http://breastfeeding.smallworldsocial.com/|title=Breastfeeding Support Project - Small World Social|date=23 April 2014|archive-url=https://web.archive.org/web/20140423100600/http://breastfeeding.smallworldsocial.com/|archive-date=2014-04-23}}</ref>

=== Telepalliative care ===
[[Palliative care]] is an [[Interdisciplinarity|interdisciplinary]] medical [[Caregiver|caregiving]] approach aimed at optimizing [[quality of life]] and mitigating [[suffering]] among people with serious, complex, and often [[Terminal illness|terminal]] [[Disease|illnesses]]. In the past, palliative care was a [[disease]] specific approach, but today the [[World Health Organization]] (WHO) takes a broader approach suggesting that palliative care should be applied as early as possible to any chronic and fatal illness. As in many aspects of [[health care]], telehealth is increasingly being used in palliative care<ref>{{Cite journal |last1=Finucane |first1=Anne M. |last2=O'Donnell |first2=Hannah |last3=Lugton |first3=Jean |last4=Gibson-Watt |first4=Tilly |last5=Swenson |first5=Connie |last6=Pagliari |first6=Claudia |date=2021-04-06 |title=Digital health interventions in palliative care: a systematic meta-review |journal=npj Digital Medicine |volume=4 |issue=1 |page=64 |doi=10.1038/s41746-021-00430-7 |pmc=8024379 |pmid=33824407}}</ref> and is often referred to as telepalliative care.<ref>{{cite journal |last1=Chen |first1=Yiping |last2=Qiao |first2=Caihong |last3=Zhang |first3=Xianhui |last4=Li |first4=Wei |last5=Yang |first5=Hui |title=The Effect of Tele-palliative Care on Patient and Caregiver Outcomes: A Systematic Review |journal=American Journal of Hospice and Palliative Medicine |date=August 2023 |volume=40 |issue=8 |pages=907–925 |doi=10.1177/10499091221123566 |pmid=36113129 }}</ref> The types of [[technology]] applied in telepalliative care are typically [[Telecommunications|telecommunication]] technologies, such as [[Videotelephony|video conferencing]] or [[Message|messaging]] for follow-up, or digital [[Signs and symptoms|symptom]] assessments through digital [[questionnaire]]s generating [[Alert messaging|alerts]] to [[Healthcare Professionals for Healthcare Reform|health care professionals.]]<ref name="Lundereng-2023">{{Cite journal |last1=Lundereng |first1=Elias David |last2=Nes |first2=Andréa Aparecida Gonçalves |last3=Holmen |first3=Heidi |last4=Winger |first4=Anette |last5=Thygesen |first5=Hilde |last6=Jøranson |first6=Nina |last7=Borge |first7=Christine Råheim |last8=Dajani |first8=Olav |last9=Mariussen |first9=Kari L. |last10=Steindal |first10=Simen A. |date=2023-03-29 |title=Health Care Professionals' Experiences and Perspectives on Using Telehealth for Home-based Palliative Care: Scoping Review |journal=Journal of Medical Internet Research |language=EN |volume=25 |issue=1 |article-number=e43429 |doi=10.2196/43429|pmid=36989024 |pmc=10131609 |doi-access=free }}</ref> Telepalliative care has been shown to be a feasible approach to deliver palliative care among [[patient]]s, [[caregiver]]s and health care professionals.<ref name="Steindal-2020">{{Cite journal |last1=Steindal |first1=Simen A. |last2=Nes |first2=Andréa Aparecida Goncalves |last3=Godskesen |first3=Tove E. |last4=Dihle |first4=Alfhild |last5=Lind |first5=Susanne |last6=Winger |first6=Anette |last7=Klarare |first7=Anna |date=2020-05-05 |title=Patients' Experiences of Telehealth in Palliative Home Care: Scoping Review |journal=Journal of Medical Internet Research |language=EN |volume=22 |issue=5 |article-number=e16218 |doi=10.2196/16218|pmid=32369037 |pmc=7238080 |doi-access=free }}</ref><ref name="Lundereng-2023" /><ref name="Steindal-2023">{{Cite journal |last1=Steindal |first1=Simen A. |last2=Nes |first2=Andréa Aparecida Gonçalves |last3=Godskesen |first3=Tove E. |last4=Holmen |first4=Heidi |last5=Winger |first5=Anette |last6=Österlind |first6=Jane |last7=Dihle |first7=Alfhild |last8=Klarare |first8=Anna |date=2023-03-13 |title=Advantages and Challenges of Using Telehealth for Home-Based Palliative Care: Systematic Mixed Studies Review |journal=Journal of Medical Internet Research |language=EN |volume=25 |issue=1 |article-number=e43684 |doi=10.2196/43684|pmid=36912876 |pmc=10131904 |doi-access=free }}</ref> Telepalliative care can provide an added support system that enable patients to remain at home through self-reporting of symptoms and tailoring care to specific patients.<ref name="Steindal-2023" /> Studies have shown that the use of telehealth in palliative care is mostly well received by patients, and that telepalliative care may improve access to [[Health professional|health care professionals]] at home and enhance feelings of security and safety among patients receiving palliative care.<ref name="Steindal-2020" /> Further, telepalliative care may enable more efficient [[Utilization management|utilization]] of healthcare [[resource]]s, promotes [[collaboration]] between different levels of healthcare, and makes healthcare professionals more responsive to changes in patients' condition.<ref name="Lundereng-2023" />

Challenging aspects of the use of telehealth in palliative care have also been described. Generally, palliative care is a diverse [[Medicine|medical]] specialty, involving [[Interdisciplinarity|interdisciplinary]] [[professional]]s from different professional [[tradition]]s and [[culture]]s, delivering care to a [[Homogeneity and heterogeneity|heterogenous]] [[Cohort (statistics)|cohort]] of patients with diverse diseases, conditions and symptoms. This makes it a challenge to develop telehealth that is suitable for all patients and in all contexts of palliative care. Some of the barriers to telepalliative care relate to inflexible reporting of complex and fluctuating symptoms and circumstances using electronic questionnaires.<ref name="Steindal-2023" /> Further, palliative care emphasizes a [[Holism|holistic]] approach that should address [[Existentialism|existential]], spiritual and [[Mental health|mental]] distress related to serious illness.<ref>{{Cite web |title=What Are Palliative Care and Hospice Care? |url=https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care |archive-url=https://web.archive.org/web/20171004193041/https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care |archive-date=October 4, 2017 |access-date=2023-04-27 |website=National Institute on Aging |date=14 May 2021 |language=en}}</ref> However, few studies have included the self-reporting of existential or spiritual concerns, [[emotion]]s, and [[well-being]].<ref name="Steindal-2023" /> Healthcare professionals may also be [[Comfort|uncomfortable]] providing emotional or [[Psychology|psychological]] care remotely.<ref name="Lundereng-2023" /> Palliative care has been characterized as high-touch rather than high-tech, limiting the interest in applying technological advancements when developing interventions.<ref>{{cite journal |last1=Head |first1=Barbara A. |last2=Schapmire |first2=Tara J. |last3=Zheng |first3=Yongqiang |title=Telehealth in Palliative Care: A Systematic Review of Patient-Reported Outcomes |journal=Journal of Hospice & Palliative Nursing |date=April 2017 |volume=19 |issue=2 |pages=130–139 |doi=10.1097/NJH.0000000000000319 }}</ref> To optimize the advantages and minimize the challenges with the use of telehealth in [[Home care|home-based]] palliative care, [[future]] [[research]] should include users in the [[design]] and development [[process]]. Understanding the potential of telehealth to support [[Therapy|therapeutic]] relationships between patients and health care professionals and being aware of the possible difficulties and tensions it may create are critical to its [[success]]ful and [[Acceptability|acceptable]] use.<ref name="Lundereng-2023" /><ref name="Steindal-2023" />

=== Telepharmacy ===
[[File:Winn Army Community Hospital Pharmacy Stays Online During Power Outage.jpg|thumb|alt=Pharmacists filling prescriptions at a computer | Pharmacy personnel deliver [[medical prescription]]s electronically. Remote delivery of [[pharmaceutical care]] is an example of '''telemedicine'''.]]
{{main|Telepharmacy}}
Telepharmacy is the delivery of [[pharmaceutical care]] via [[telecommunications]] to patients in locations where they may not have direct contact with a [[pharmacist]]. It is an instance of the wider phenomenon of telemedicine, as implemented in the field of [[pharmacy]]. Telepharmacy services include [[drug therapy]] monitoring, patient counseling, prior authorization and refill authorization for [[prescription drugs]], and monitoring of [[Formulary (pharmacy)|formulary]] compliance with the aid of [[teleconferencing]] or [[videoconferencing]]. [[Remote dispensing]] of medications by automated packaging and labeling systems can also be thought of as an instance of telepharmacy. Telepharmacy services can be delivered at retail pharmacy sites or through [[Hospital|hospitals]], [[Nursing home|nursing homes]], or other medical care facilities. This approach allows patients in remote or underserved areas to receive pharmacy services that would otherwise be unavailable to them, enhancing access to care and ensuring continuity in medication management.<ref>{{Cite journal |last1=Poudel |first1=Arjun |last2=Nissen |first2=Lisa M. |date=2016-10-26 |title=Telepharmacy: a pharmacist's perspective on the clinical benefits and challenges |journal=Integrated Pharmacy Research and Practice |language=English |volume=5 |pages=75–82 |doi=10.2147/IPRP.S101685 |doi-access=free |pmc=5741040 |pmid=29354542}}</ref> Health outcomes appear similar when pharmacy services are delivered by telepharmacy compared to traditional service delivery.<ref>{{cite journal | vauthors = Lowry SJ, Kay CN, Marsom EN, Park JS, Poole S, Page AT | title=Optimising health outcomes via pharmacist delivered telehealth medicines management: a systematic review | journal=Journal of Pharmacy Practice and Research | publisher=Wiley | volume=50 | issue=5 | year=2020 |doi=10.1002/jppr.1695 | pages=377–390 | doi-access=free }}</ref>

The term can also refer to the use of videoconferencing in pharmacy for other purposes, such as providing education, training, and management services to pharmacists and pharmacy staff remotely.<ref name="Angaran" />

=== Telepsychiatry ===
{{Excerpt|Telepsychiatry}}

=== Teledentistry ===
{{main|Teledentistry}}
Teledentistry is the use of [[information technology]] and [[telecommunications]] for dental care, consultation, education, and public awareness in the same manner as telehealth and telemedicine.

=== Teleaudiology ===
{{main|Tele-audiology}}
Tele-audiology (or teleaudiology) is the utilization of telehealth to provide [[audiological]] services and may include the full scope of audiological practice. This term was first used by Gregg Givens in 1999 in reference to a system being developed at [[East Carolina University]] in North Carolina, US.<ref>{{cite journal |last1=Givens |first1=Gregg D. |last2=Elangovan |first2=Saravanan |title=Internet Application to Tele-Audiology—'Nothin' but Net' |journal=American Journal of Audiology |date=December 2003 |volume=12 |issue=2 |pages=59–65 |doi=10.1044/1059-0889(2003/011) |pmid=14964319 }}</ref>

===Teleneurotherapy===
Teleneurotherapy uses computers and communications technology to deliver [[neurotherapy]] remotely.<ref name="2503290_2025">{{cite journal |last1=Danilov |first1=Igor Val |last2=Medne |first2=Dace |last3=Mihailova |first3=Sandra |title=Natural Neurostimulation for Chronic Pain Management: A Case Series of 3 Patients with Dysmenorrhea and Menstrual Migraine |journal=OBM Neurobiology |date=3 July 2025 |volume=09 |issue=3 |pages=1–11 |doi=10.21926/obm.neurobiol.2503290 }}</ref> Organisms receive physical stimuli, such as [[Sound|sounds]] (through [[Mechanoreceptor|mechanoreceptors]] and [[Mitochondrion|mitochondria]] across different organ systems) and [[light]] (through [[Eyespot apparatus|photoreceptors]] located in the retina and mitochondria) that alter neuronal activity in specific brain zones.<ref name="Val Danilov Origin Neurostimulation_2024">{{cite journal |last1=Danilov |first1=Igor Val |title=The Origin of Natural Neurostimulation: A Narrative Review of Noninvasive Brain Stimulation Techniques |journal=OBM Neurobiology |date=29 November 2024 |volume=8 |issue=4 |pages=1–23 |doi=10.21926/obm.neurobiol.2404260 }}</ref> Research indicates that systematic physical stimuli produced by standard electronic devices, such as tablets with headphones, may treat online injured [[Nervous system|nervous systems]] by modulating neuronal [[Neuroplasticity|plasticity]].<ref name="2503290_2025" /> Evidence suggests that teleneurotherapy may elevate neurological treatment if it considers the treating effect of a systematic abiotic impact of physical forces with key parameters of the mother-fetus interaction.<ref name="2503290_2025" /><ref name="Val Danilov et al_2025">{{cite journal |last1=Danilov |first1=Igor Val |last2=Medne |first2=Dace |last3=Mihailova |first3=Sandra |title=Modulating neuroplasticity with acoustic photonic intellectual neurostimulation (APIN): a case study on neurodegenerative disorder |journal=Brain Stimulation |date=January 2025 |volume=18 |issue=1 |page=561 |doi=10.1016/j.brs.2024.12.1005 }}</ref><ref name="Mihailova et al_2025">{{cite journal |last1=Mihailova |first1=Sandra |last2=Medne |first2=Dace |last3=Danilov |first3=Igor Val |title=Acoustic photonic intellectual neurostimulation (APIN) in dysmenorrhea management: a case study on an adolescent |journal=Brain Stimulation |date=January 2025 |volume=18 |issue=1 |page=510 |doi=10.1016/j.brs.2024.12.860 }}</ref><ref name="Medne et al_2025">{{cite journal |last1=Medne |first1=Dace |last2=Danilov |first2=Igor Val |last3=Mihailova |first3=Sandra |title=The effect of acoustic and photonic intervention combined with mental load on chronic headaches: a case study |journal=Brain Stimulation |date=January 2025 |volume=18 |issue=1 |pages=542–543 |doi=10.1016/j.brs.2024.12.955 }}</ref> Recent research implemented the APIN method (see above) in the online treatment of patients with different neurological conditions, which showed therapeutic effects.<ref name="2503290_2025" /><ref name="Val Danilov et al_2025" /><ref name="Mihailova et al_2025" /><ref name="Medne et al_2025" />

=== Teleneurology ===
Teleneurology describes the use of [[mobile technology]] to provide neurological care remotely, including care for stroke, movement disorders like Parkinson's disease, seizure disorders (e.g., epilepsy), etc.<ref name="Teleneurology and mobile technologi">{{cite journal | vauthors = Dorsey ER, Glidden AM, Holloway MR, Birbeck GL, Schwamm LH | title = Teleneurology and mobile technologies: the future of neurological care | journal = Nature Reviews. Neurology | volume = 14 | issue = 5 | pages = 285–297 | date = May 2018 | pmid = 29623949 | doi = 10.1038/nrneurol.2018.31 }}</ref> The term teleneurology implies remote education, diagnostic assistance, and consultation, while it does not involve non-invasive remote targeted delivery of an energy stimulus to a specific neurological zone in the body to alter neuronal activity.<ref name="Teleneurology and mobile technologi"/> The use of teleneurology gives us the opportunity to improve health care access for billions around the globe, from those living in urban locations to those in remote, rural locations. Evidence shows that individuals with Parkinson's disease prefer personal connection with a remote specialist to their local clinician. Such home care is convenient but requires access to and familiarity with the Internet.<ref name="Teleneurology and mobile technologi"/><ref name="neurology.org">{{cite journal | vauthors = Beck CA, Beran DB, Biglan KM, Boyd CM, Dorsey ER, Schmidt PN, Simone R, Willis AW, Galifianakis NB, Katz M, Tanner CM, Dodenhoff K, Aldred J, Carter J, Fraser A, Jimenez-Shahed J, Hunter C, Spindler M, Reichwein S, Mari Z, Dunlop B, Morgan JC, McLane D, Hickey P, Gauger L, Richard IH, Mejia NI, Bwala G, Nance M, Shih LC, Singer C, Vargas-Parra S, Zadikoff C, Okon N, Feigin A, Ayan J, Vaughan C, Pahwa R, Dhall R, Hassan A, DeMello S, Riggare SS, Wicks P, Achey MA, Elson MJ, Goldenthal S, Keenan HT, Korn R, Schwarz H, Sharma S, Stevenson EA, Zhu W | title = National randomized controlled trial of virtual house calls for Parkinson disease | journal = Neurology | volume = 89 | issue = 11 | pages = 1152–1161 | date = September 2017 | pmid = 28814455 | pmc = 5595275 | doi = 10.1212/WNL.0000000000004357 }}</ref> A 2017 randomized controlled trial of "virtual house calls" or video visits with individuals diagnosed with Parkinson's disease evidences patient preference for the remote specialist vs their local clinician after one year.<ref name="neurology.org"/> Teleneurology for patients with Parkison's disease is found to be cheaper than in person visits by reducing transportation and travel time<ref name="The Promise of Telemedicine for Mov">{{cite journal | vauthors = Ben-Pazi H, Browne P, Chan P, Cubo E, Guttman M, Hassan A, Hatcher-Martin J, Mari Z, Moukheiber E, Okubadejo NU, Shalash A | title = The Promise of Telemedicine for Movement Disorders: an Interdisciplinary Approach | journal = Current Neurology and Neuroscience Reports | volume = 18 | issue = 5 | article-number = 26 | date = April 2018 | pmid = 29654523 | doi = 10.1007/s11910-018-0834-6 }}</ref><ref name="National randomized controlled tria">{{cite journal | vauthors = Beck CA, Beran DB, Biglan KM, Boyd CM, Dorsey ER, Schmidt PN, Simone R, Willis AW, Galifianakis NB, Katz M, Tanner CM, Dodenhoff K, Aldred J, Carter J, Fraser A, Jimenez-Shahed J, Hunter C, Spindler M, Reichwein S, Mari Z, Dunlop B, Morgan JC, McLane D, Hickey P, Gauger L, Richard IH, Mejia NI, Bwala G, Nance M, Shih LC, Singer C, Vargas-Parra S, Zadikoff C, Okon N, Feigin A, Ayan J, Vaughan C, Pahwa R, Dhall R, Hassan A, DeMello S, Riggare SS, Wicks P, Achey MA, Elson MJ, Goldenthal S, Keenan HT, Korn R, Schwarz H, Sharma S, Stevenson EA, Zhu W | title = National randomized controlled trial of virtual house calls for Parkinson disease | journal = Neurology | volume = 89 | issue = 11 | pages = 1152–1161 | date = September 2017 | pmid = 28814455 | pmc = 5595275 | doi = 10.1212/WNL.0000000000004357 | doi-access = free }}</ref> A recent systematic review by Ray Dorsey et al.<ref name="Teleneurology and mobile technologi"/> describes both the limitations and potential benefits of teleneurology in improving care for patients with chronic neurological conditions, especially in low-income countries. White, well-educated and technologically savvy people are the biggest consumers of telehealth services for Parkinson's disease.<ref name="The Promise of Telemedicine for Mov"/><ref name="National randomized controlled tria"/> as compared to ethnic minorities in the US.<ref name="National randomized controlled tria"/>

=== Teleneurosurgery ===

Telemedicine in neurosurgery was historically primarily used for follow-up visits by patients who had to travel far to undergo surgery.<ref>{{cite journal | vauthors = Appelboom G, Yang AH, Christophe BR, Bruce EM, Slomian J, Bruyère O, Bruce SS, Zacharia BE, Reginster JY, Connolly ES | title = The promise of wearable activity sensors to define patient recovery | journal = Journal of Clinical Neuroscience | volume = 21 | issue = 7 | pages = 1089–1093 | date = July 2014 | pmid = 24534628 | doi = 10.1016/j.jocn.2013.12.003 | author10-link = E. Sander Connolly }}</ref> In the last decade, telemedicine was also used for remote ICU rounding as well as prompt evaluation for acute ischemic stroke and administration of IV alteplase in conjunction with neurology.<ref>{{cite journal | vauthors = Lazarus G, Permana AP, Nugroho SW, Audrey J, Wijaya DN, Widyahening IS | title = Telestroke strategies to enhance acute stroke management in rural settings: A systematic review and meta-analysis | journal = Brain and Behavior | volume = 10 | issue = 10 | article-number = e01787 | date = October 2020 | pmid = 32812380 | pmc = 7559631 | doi = 10.1002/brb3.1787 }}</ref><ref>{{cite journal | vauthors = Chalouhi N, Dressler JA, Kunkel ES, Dalyai R, Jabbour P, Gonzalez LF, Starke RM, Dumont AS, Rosenwasser R, Tjoumakaris S | title = Intravenous tissue plasminogen activator administration in community hospitals facilitated by telestroke service | journal = Neurosurgery | volume = 73 | issue = 4 | pages = 667–71; discussion 671–2 | date = October 2013 | pmid = 23842556 | doi = 10.1227/NEU.0000000000000073 }}</ref> From the onset of the COVID-19 pandemic, there was a rapid surge in the use of telemedicine across all divisions of neurosurgery: vascular, oncology, spine, and functional neurosurgery. Not only for follow-up visits, but it has gained popularity for seeing new patients or following established patients regardless of whether they underwent surgery.<ref>{{cite journal | vauthors = Mouchtouris N, Yu S, Prashant G, Nelson N, Reyes M, Gonzalez G, Smit R, Collopy S, Jabbour P, Sharan A, Harrop J, Rosenwasser R, Evans JJ | title = Telemedicine in Neurosurgery During the COVID-19 Outbreak: Where We Are 1 Year Later | journal = World Neurosurgery | volume = 163 | pages = e83–e88 | date = July 2022 | pmid = 35306198 | pmc = 8925084 | doi = 10.1016/j.wneu.2022.03.037 }}</ref><ref>{{cite journal | vauthors = Mouchtouris N, Lavergne P, Montenegro TS, Gonzalez G, Baldassari M, Sharan A, Jabbour P, Harrop J, Rosenwasser R, Evans JJ | title = Telemedicine in Neurosurgery: Lessons Learned and Transformation of Care During the COVID-19 Pandemic | journal = World Neurosurgery | volume = 140 | pages = e387–e394 | date = August 2020 | pmid = 32512241 | pmc = 7274123 | doi = 10.1016/j.wneu.2020.05.251 }}</ref> Telemedicine is not limited to direct patient care only; there are a number of new research groups and companies focused on using telemedicine for clinical trials involving patients with neurosurgical diagnoses.

=== Teleneuropsychology ===
Teleneuropsychology is the use of telehealth/videoconference technology for the remote administration of [[Neuropsychological test|neuropsychological tests]]. Neuropsychological tests are used to evaluate the cognitive status of individuals with known or suspected [[Neurological disorder|brain disorders]] and provide a profile of cognitive strengths and weaknesses. Through a series of studies, there is growing support in the literature showing that remote videoconference-based administration of many standard neuropsychological tests results in test findings similar to traditional in-person evaluations, thereby establishing the basis for the reliability and validity of teleneuropsychological assessment.<ref>{{cite journal | vauthors = Wadsworth HE, Dhima K, Womack KB, Hart J, Weiner MF, Hynan LS, Cullum CM | title = Validity of Teleneuropsychological Assessment in Older Patients with Cognitive Disorders | journal = Archives of Clinical Neuropsychology | volume = 33 | issue = 8 | pages = 1040–1045 | date = December 2018 | pmid = 29329363 | pmc = 6887729 | doi = 10.1093/arclin/acx140 }}</ref><ref>{{cite journal | vauthors = Wadsworth HE, Galusha-Glasscock JM, Womack KB, Quiceno M, Weiner MF, Hynan LS, Shore J, Cullum CM | title = Remote Neuropsychological Assessment in Rural American Indians with and without Cognitive Impairment | journal = Archives of Clinical Neuropsychology | volume = 31 | issue = 5 | pages = 420–425 | date = August 2016 | pmid = 27246957 | pmc = 4954610 | doi = 10.1093/arclin/acw030 }}</ref><ref>{{cite journal | vauthors = Galusha-Glasscock JM, Horton DK, Weiner MF, Cullum CM | title = Video Teleconference Administration of the Repeatable Battery for the Assessment of Neuropsychological Status | journal = Archives of Clinical Neuropsychology | volume = 31 | issue = 1 | pages = 8–11 | date = February 2016 | pmid = 26446834 | pmc = 4718188 | doi = 10.1093/arclin/acv058 }}</ref><ref>{{cite journal | vauthors = Parikh M, Grosch MC, Graham LL, Hynan LS, Weiner M, Shore JH, Cullum CM | title = Consumer acceptability of brief videoconference-based neuropsychological assessment in older individuals with and without cognitive impairment | journal = The Clinical Neuropsychologist | volume = 27 | issue = 5 | pages = 808–817 | year = 2013 | pmid = 23607729 | pmc = 3692573 | doi = 10.1080/13854046.2013.791723 }}</ref><ref>{{cite journal | vauthors = Grosch MC, Gottlieb MC, Cullum CM | title = Initial practice recommendations for teleneuropsychology | journal = The Clinical Neuropsychologist | volume = 25 | issue = 7 | pages = 1119–1133 | date = October 2011 | pmid = 21951075 | doi = 10.1080/13854046.2011.609840 }}</ref><ref>{{cite journal | vauthors = Munro Cullum C, Hynan LS, Grosch M, Parikh M, Weiner MF | title = Teleneuropsychology: evidence for video teleconference-based neuropsychological assessment | journal = Journal of the International Neuropsychological Society | volume = 20 | issue = 10 | pages = 1028–1033 | date = November 2014 | pmid = 25343269 | pmc = 4410096 | doi = 10.1017/S1355617714000873 }}</ref><ref>{{cite report |title=Mindfulness-based cognitive therapy, delivered as supported self-help, can help people with depression |date=11 October 2023 |doi=10.3310/nihrevidence_59926 }}</ref>

=== Telenutrition ===
Telenutrition refers to the use of video conferencing/ telephony to provide online consultation by a [[nutritionist]] or [[Dietitian|dietician]]. Patient or clients upload their vital statistics, diet logs, food pictures, etc., on a telenutrition portal that is then used by the nutritionist or dietician to analyze their current health condition. The nutritionist or dietician can then set goals for their respective clients/patients and monitor their progress regularly by follow-up consultations.

Telenutrition portals can help people seek remote consultation for themselves and/or their family. This can be extremely helpful for elderly or bedridden patients who can consult their dietician from comfort of their homes.

Telenutrition showed to be feasible, and the majority of patients trusted the nutritional televisits, in place of the scheduled but not provided follow-up visits during the lockdown of the COVID-19 pandemic.<ref>{{cite journal |last1=Costantino |first1=Andrea |last2=Roncoroni |first2=Leda |last3=Noviello |first3=Daniele |last4=Nandi |first4=Nicoletta |last5=Lombardo |first5=Vincenza |last6=Scricciolo |first6=Alice |last7=Scaramella |first7=Lucia |last8=Vecchi |first8=Maurizio |last9=Elli |first9=Luca |title=Nutritional and Gastroenterological Monitoring of Patients With Celiac Disease During COVID-19 Pandemic: The Emerging Role of Telemedicine and Point-of-Care Gluten Detection Tests |journal=Frontiers in Nutrition |date=13 April 2021 |volume=8 |article-number=622514 |doi=10.3389/fnut.2021.622514 |doi-access=free |pmid=33928109 |pmc=8076748 }}</ref>

=== Telerehabilitation ===
{{main|Telerehabilitation}}
[[File:Telemedicine in rehabilitation 2.jpg|thumb|Telemedicine in rehabilitation]]
Telerehabilitation (or ''e-rehabilitation''<ref name="dl-2005">{{cite book |editor1-last=Tan |editor1-first=Joseph |title=E-Health Care Information Systems: An Introduction for Students and Professionals |date=2005 |publisher=John Wiley & Sons |isbn=978-0-7879-7741-2 |page=219 }}</ref><ref>{{cite journal |last1=Keaton |first1=Lisa |last2=Pierce |first2=Linda |last3=Steiner |first3=Victoria |last4=Lance |first4=Karen |last5=Masterson |first5=Michelle |last6=Rice |first6=Martin |last7=Smith |first7=Julie |title=An E-rehabilitation Team Helps Caregivers Deal with Stroke |journal=Internet Journal of Allied Health Sciences and Practice |date=2004 |doi=10.46743/1540-580X/2004.1057 }}</ref>) is the delivery of [[Physical medicine and rehabilitation|rehabilitation]] services over [[telecommunication network]]s and the Internet. Most types of services fall into two categories: clinical assessment (the patient's functional abilities in his or her environment) and [[medical therapy|clinical therapy]]. Some fields of rehabilitation practice that have explored telerehabilitation are: [[neuropsychology]], [[speech–language pathology]], [[audiology]], [[occupational therapy]], and [[physical therapy]]. Telerehabilitation can deliver therapy to people who cannot travel to a [[clinic]] because the patient has a [[disability]] or because of travel time. Telerehabilitation also allows experts in rehabilitation to engage in clinical consultation at a distance.

Most telerehabilitation is highly visual. As of 2014, the most commonly used mediums are [[webcam]]s, [[videoconferencing]], [[phone line]]s, [[videophone]]s, and webpages containing [[Rich Internet Application|rich web applications]]. The visual nature of telerehabilitation technology limits the types of rehabilitation services that can be provided. It is most widely used for [[neuropsychological rehabilitation]], fitting of rehabilitation equipment such as [[wheelchair]]s, [[Brace (orthopaedic)|braces]], or [[artificial limb]]s, and in speech-language pathology. [[Rich web applications]] for neuropsychological rehabilitation ([[cognitive rehabilitation]]) of cognitive impairment (from many etiologies) were first introduced in 2001. This endeavor has expanded as a [[teletherapy]] application for cognitive skills enhancement programs for school children. [[Tele-audiology]] (hearing assessments) is a growing application. Physical therapy and psychology interventions delivered via telehealth may result in similar outcomes as those delivered in person for a range of health conditions.<ref>{{Cite journal |last1=Raymond |first1=Melissa J. |last2=Christie |first2=Lauren J. |last3=Kramer |first3=Sharon |last4=Malaguti |first4=Carla |last5=Mok |first5=Zaneta |last6=Gardner |first6=Betina |last7=Giummarra |first7=Melita J. |last8=Alves-Stein |first8=Serena |last9=Hudson |first9=Claire |last10=Featherston |first10=Jill |last11=Holland |first11=Anne E. |last12=Lannin |first12=Natasha A. |date=2024-02-07 |title=Delivery of Allied Health Interventions Using Telehealth Modalities: A Rapid Systematic Review of Randomized Controlled Trials |journal=Healthcare |language=en |volume=12 |issue=12 |page=1217 |doi=10.3390/healthcare12121217 |doi-access=free |pmid=38921331 |pmc=11203162 }}</ref>

Two important areas of telerehabilitation research are (1) demonstrating equivalence of assessment and therapy to in-person assessment and therapy and (2) building new data collection systems to digitize information that a therapist can use in practice. Ground-breaking research in [[telehaptics]] (the sense of touch) and virtual reality may broaden the scope of telerehabilitation practice in the future.

In the United States, the [[National Institute on Disability and Rehabilitation Research]]'s (NIDRR)<ref>{{cite web|url=http://www.ed.gov/about/offices/list/osers/nidrr/index.html?src=mr|title=OSERS|website=www.ed.gov|archive-url=https://web.archive.org/web/20031011114426/http://www.ed.gov/about/offices/list/osers/nidrr/index.html?src=mr|archive-date=2003-10-11}}</ref> supports research and the development of telerehabilitation. NIDRR's grantees include the "Rehabilitation Engineering and Research Center" (RERC) at the [[University of Pittsburgh]], the [[Rehabilitation Institute of Chicago]], the State University of New York at Buffalo, and the National Rehabilitation Hospital in [[Washington, D.C.|Washington, D.C]]. Other federal funders of research are the [[Veterans Health Administration]], the Health Services Research Administration in the US Department of Health and Human Services, and the [[United States Department of Defense|Department of Defense]].<ref>{{cite web| vauthors = Hiers M | title = Everything You Need to Know About Telemedicine| date = 17 June 2014| url = http://www.accessrx.com/blog/current-health-news/everything-you-need-to-know-about-telemedicine-m0525/| access-date = 10 July 2014 }}</ref> Outside the United States, excellent research is conducted in [[Australia]] and [[Europe]].

Only a few [[Health insurance|health insurers]] in the United States, and about half of [[Medicaid]] programs,<ref>{{cite journal | vauthors = Palsbo SE | title = Medicaid payment for telerehabilitation | journal = Archives of Physical Medicine and Rehabilitation | volume = 85 | issue = 7 | pages = 1188–1191 | date = July 2004 | pmid = 15241772 | doi = 10.1016/j.apmr.2003.09.008 }}</ref> [[reimburse]] for telerehabilitation services. If the research shows that teleassessments and teletherapy are equivalent to clinical encounters, it is more likely that [[insurer]]s and [[Medicare (United States)|Medicare]] will cover telerehabilitation services.

In [[India]], the Indian Association of Chartered Physiotherapists (IACP) provides telerehabilitation facilities. With the support and collaboration of local clinics and private practitioners and the Members IACP, IACP runs the facility, named Telemedicine. IACP has maintained an internet-based list of their members on their website, through which patients can make online appointments.

=== Teletrauma care ===
Telemedicine can be utilized to improve the efficiency and effectiveness of care delivery in a trauma environment. Examples include:

Telemedicine for trauma triage: using telemedicine, trauma specialists can interact with personnel on the scene of a mass casualty or disaster situation via the internet using mobile devices to determine the severity of injuries. They can provide clinical assessments and determine whether those injured must be evacuated for necessary care. Remote trauma specialists can provide the same quality of clinical assessment and plan of care as a trauma specialist located physically with the patient.<ref>{{cite journal | vauthors = Collins H | title = Advanced First Responder and Medical Capabilities Could Save Lives | journal = Emergency Management | date = 28 August 2008 | url = http://www.emergencymgmt.com/disaster/Advanced-First-Responder-and.html | access-date = 23 June 2019 | archive-date = 18 August 2016 | archive-url = https://web.archive.org/web/20160818095412/http://www.emergencymgmt.com/disaster/Advanced-First-Responder-and.html }}</ref>

Telemedicine for [[intensive care unit]] (ICU) rounds: Telemedicine is also being used in some trauma ICUs to reduce the spread of infections. Rounds are usually conducted at hospitals across the country by a team of approximately ten or more people including attending physicians, fellows, residents, and other clinicians. This group usually moves from bed to bed in a unit, discussing each patient. This aids in the transition of care for patients from the night shift to the morning shift but also serves as an educational experience for new residents to the team. A new approach features the team conducting rounds from a conference room using a video-conferencing system. The trauma attending, residents, fellows, nurses, nurse practitioners, and pharmacists are able to watch a live video stream from the patient's bedside. They can see the vital signs on the monitor, view the settings on the respiratory ventilator, and/or view the patient's wounds. Video-conferencing allows remote viewers to conduct two-way communication with clinicians at the bedside.<ref>{{cite web | title = Advanced technologies and wireless telecommunications enhance care and medical training at the Ryder Trauma Center in Miami | publisher = Virtual Medical Worlds | date = 4 December 2008 | url = http://www.hoise.com/vmw/09/articles/vmw/LV-VM-01-09-10.html | access-date = 23 July 2013}}</ref>

Telemedicine for trauma education: some trauma centers are delivering trauma education lectures to hospitals and health care providers worldwide using video conferencing technology. Each lecture provides fundamental principles, first-hand knowledge, and evidenced-based methods for critical analysis of established clinical practice standards, and comparisons to newer advanced alternatives. The various sites collaborate and share their perspective based on location, available staff, and available resources.<ref>{{cite web| title = EMS Trauma Grand Rounds| publisher = Utah Telehealth Network| access-date = 23 July 2013| url = http://www.utahtelehealth.net/education/ems_trauma.html| archive-url = https://web.archive.org/web/20090916083826/http://www.utahtelehealth.net/education/ems_trauma.html| archive-date = 16 September 2009}}</ref>

Telemedicine in the trauma operating room: trauma surgeons are able to observe and consult on cases from a remote location using video conferencing. This capability allows the attending to view the residents in real time. The remote surgeon has the capability to control the camera (pan, tilt, and zoom) to get the best angle of the procedure while at the same time providing expertise in order to provide the best possible care to the patient.<ref>{{cite news | vauthors = Gonzalez D | title = UM Doctors Use Telemedicine to Continue Care In Iraq | date = 10 November 2011 | url = http://www.nbcmiami.com/news/local/UM-Doctors-Use-Tele-133650778.html | access-date = 23 July 2013}}</ref>

=== Telecardiology ===
ECGs, or [[Electrocardiography|electrocardiographs]], can be transmitted using telephone and wireless. [[Willem Einthoven]], the inventor of the ECG, actually did tests with the transmission of ECG via telephone lines. This was because the hospital did not allow him to move patients outside the hospital to his laboratory for testing of his new device. In 1906, Einthoven came up with a way to transmit the data from the hospital directly to his lab.<ref>[https://web.archive.org/web/20100826163357/http://www.medetel.lu/download/2009/parallel_sessions/presentation/day1/telecardiology_and_tele-ecg_network.pdf Telecardiology].</ref><ref>General health care delivery. Remotely treating ventricular fibrillation. Medphone Corporation, 1989{{vs|date=July 2025}}</ref>

==== Transmission of ECGs ====
One of the oldest known telecardiology systems for teletransmissions of ECGs was established in Gwalior, India, in 1975 at GR Medical College by Ajai Shanker, S. Makhija, P.K. Mantri using an indigenous technique for the first time in India.

This system enabled wireless transmission of ECG from the moving ICU van or the patients home to the central station in ICU of the department of Medicine. Transmission using wireless was done using frequency modulation which eliminated noise. Transmission was also done through telephone lines. The ECG output was connected to the telephone input using a modulator that converted ECG into high-frequency sound. At the other end a demodulator reconverted the sound into ECG with a good gain accuracy. The ECG was converted to sound waves with a frequency varying from 500&nbsp;Hz to 2500&nbsp;Hz with 1500&nbsp;Hz at baseline.

This system was also used to monitor patients with pacemakers in remote areas. The central control unit at the ICU was able to correctly interpret [[arrhythmia]]. This technique helped medical aid reach in remote areas.<ref>{{cite journal | vauthors = Shanker A, Makhija S, Mantri PK | title = Teletransmission of ECG Waveform: An Ingenious Low Priced Technique | journal = Indian Heart Journal | year = 1982 | volume = 34 | number = 6}}</ref>

In addition, [[Stethoscope#Electronic|electronic stethoscopes]] can be used as recording devices, which is helpful for purposes of telecardiology. There are many examples of successful telecardiology services worldwide.

In [[Pakistan]], three pilot projects in telemedicine were initiated by the Ministry of IT & Telecom, Government of Pakistan (MoIT) through the Electronic Government Directorate in collaboration with Oratier Technologies (a pioneer company within Pakistan dealing with healthcare and HMIS) and PakDataCom (a bandwidth provider). Three hub stations through were linked via the Pak Sat-I communications satellite, and four districts were linked with another hub. A 312&nbsp;Kb link was also established with remote sites and 1&nbsp;Mbit/s bandwidth was provided at each hub. Three hubs were established: the Mayo Hospital (the largest hospital in Asia), JPMC Karachi, and Holy Family Rawalpindi. These 12 remote sites were connected and an average of 1,500 patients were treated per month per hub. The project was still running smoothly after two years.{{fact|date=July 2025}}

[[Wireless ambulatory ECG|Wireless ambulatory ECG technology]], moving beyond previous ambulatory ECG technology such as the [[Holter monitor]], now includes smartphones and [[Apple Watch|Apple Watches]], which can perform at-home cardiac monitoring and send the data to a physician via the Internet.<ref>{{cite journal |last1=Sanders |first1=David |last2=Ungar |first2=Leo |last3=Eskander |first3=Michael A. |last4=Seto |first4=Arnold H. |title=Ambulatory ECG monitoring in the age of smartphones |journal=Cleveland Clinic Journal of Medicine |date=July 2019 |volume=86 |issue=7 |pages=483–493 |doi=10.3949/ccjm.86a.18123 |doi-access=free |pmid=31291182 }}</ref>

=== Teleradiology ===
{{main|Teleradiology}}
[[File:CT viewer Chest Keosys.JPG|right|thumb|A CT exam displayed through teleradiology]]

Teleradiology is the ability to send [[Radiography|radiographic]] images ([[X-ray]]s, CT, MR, PET/CT, SPECT/CT, MG, US...) from one location to another.<ref>{{cite journal | vauthors = Kontaxakis G, Visvikis D, Ohl R, Sachpazidis I, Suarez JP, Selby P, Cheze-Le Rest C, Santos A, Ortega F, Diaz J, Pan L, Strauss L, Dimitrakopoulou-Strauss A, Sakas G, Pozo MA | title = Integrated telemedicine applications and services for oncological positron emission tomography | journal = Oncology Reports | volume = 15 | issue = 4 | pages = 1091–1100 | year = 2006 | pmid = 16525707 | doi = 10.3892/or.15.4.1091 | doi-access = free }}</ref> For this process to be implemented, three essential components are required: an image-sending station, a transmission network, and a receiving-image review station. The most typical implementation is two computers connected via the Internet. The computer at the receiving end will need a high-quality display screen that has been tested and cleared for clinical purposes. Sometimes the receiving computer will have a printer for convenience.

The teleradiology process begins at the image-sending station. The radiographic image and a modem or other connection are required for this first step. The image is scanned and then sent via the network connection to the receiving computer.

Today's high-speed broadband-based Internet enables the use of new technologies for teleradiology: the image reviewer can now have access to distant servers in order to view an exam. Therefore, they do not need particular workstations to view the images; a standard [[personal computer]] (PC) and [[digital subscriber line]] (DSL) connection is enough to reach Keosys' central server. No particular software is necessary on the PC, and the images can be reached from anywhere in the world.

Teleradiology is the most popular use for telemedicine and accounts for at least 50% of all telemedicine usage.

=== Telepathology ===
{{main|Telepathology}}

Telepathology is the practice of [[pathology]] at a distance. It uses [[telecommunications|telecommunications technology]] to facilitate the transfer of image-rich pathology data between distant locations for the purposes of [[Medical diagnosis|diagnosis]], [[Medical education|education]], and [[Medical research|research]].<ref>{{cite journal | vauthors = Weinstein RS, Graham AR, Richter LC, Barker GP, Krupinski EA, Lopez AM, Erps KA, Bhattacharyya AK, Yagi Y, Gilbertson JR | title = Overview of telepathology, virtual microscopy, and whole slide imaging: prospects for the future | journal = Human Pathology | volume = 40 | issue = 8 | pages = 1057–1069 | date = August 2009 | pmid = 19552937 | doi = 10.1016/j.humpath.2009.04.006 }}</ref><ref>{{cite book | vauthors = Kumar S | title = Telepathology | chapter = Telepathology: An Audit | veditors = Kumar S, Dunn BE | publisher = Springer-Verlag Berlin Heidelberg | year = 2009 | pages = 225–229| doi = 10.1007/978-3-540-85786-0_16 | isbn = 978-3-540-85785-3 }}</ref> The performance of telepathology requires that a pathologist selects the [[video]] images for analysis and rendering diagnoses. The use of "[[microscopy|television microscopy]]", the forerunner of telepathology, did not require that a pathologist have physical or virtual "hands-on" involvement in the selection of microscopic fields of view for analysis and diagnosis.

A pathologist, Ronald S. Weinstein, M.D., coined the term "telepathology" in 1986. In an editorial in a medical journal, Weinstein outlined the actions that would be needed to create remote pathology diagnostic services.<ref>{{cite journal | vauthors = Weinstein RS | title = Prospects for telepathology | journal = Human Pathology | volume = 17 | issue = 5 | pages = 433–434 | date = May 1986 | pmid = 3516858 | doi = 10.1016/s0046-8177(86)80028-4 }}</ref> He and his collaborators published the first scientific paper on robotic telepathology.<ref>{{cite journal | vauthors = Weinstein RS, Bloom KJ, Rozek LS | title = Telepathology and the networking of pathology diagnostic services | journal = Archives of Pathology & Laboratory Medicine | volume = 111 | issue = 7 | pages = 646–652 | date = July 1987 | pmid = 3606341 }}</ref> Weinstein was also granted the first U.S. [[patents]] for [[robotics|robotic]] telepathology systems and telepathology diagnostic networks.<ref>{{cite book |last1=Kayser |first1=Klaus |last2=Szymas |first2=Janusz |last3=Weinstein |first3=Ronald S. |title=Telepathology: Telecommunication, Electronic Education and Publication in Pathology |date=1999 |publisher=Springer Berlin Heidelberg |isbn=978-3-540-65245-8 }}{{pn|date=July 2025}}</ref> Weinstein is known to many as the "father of telepathology".<ref>{{cite web | title = ReUnion '10 award winners | publisher = Union College | url = http://www.union.edu/N/DS/s.php?s=8942 | archive-url = https://archive.today/20120805232102/http://www.union.edu/N/DS/s.php?s=8942 | archive-date = 5 August 2012 | access-date = 25 July 2013}}</ref> In [[Norway]], Eide and Nordrum implemented the first sustainable clinical telepathology service in 1989.<ref>{{cite journal | vauthors = Nordrum I, Engum B, Rinde E, Finseth A, Ericsson H, Kearney M, Stalsberg H, Eide TJ | title = Remote frozen section service: a telepathology project in northern Norway | journal = Human Pathology | volume = 22 | issue = 6 | pages = 514–518 | date = June 1991 | pmid = 1864583 | doi = 10.1016/0046-8177(91)90226-F }}</ref> This is still in operation, decades later. A number of clinical telepathology services have benefited many thousands of patients in North America, Europe, and Asia.

Telepathology has been successfully used for many applications, including the rendering [[histopathology]] tissue diagnoses at a distance, for education and research. Although [[digital pathology]] imaging, including [[virtual microscopy]], is the mode of choice for telepathology services in developed countries, [[Analog signal|analog]] telepathology imaging is still used for patient services in some [[Developing country|developing countries]].

=== Teledermatology ===
{{main|Teledermatology}}

Teledermatology allows [[dermatology]] consultations over a distance using audio, visual and [[data communication]], and has been found to improve efficiency, access to specialty care, and patient satisfaction.<ref>{{cite web |publisher=Agency for Healthcare Research and Quality | url=https://innovations.ahrq.gov/profiles/online-visits-dermatologists-enhance-access-care-patients-minor-and-serious-skin-conditions |title=Online Visits With Dermatologists Enhance Access to Care for Patients With Minor and Serious Skin Conditions, Boost Physician Productivity |date=2013-11-06 | access-date=6 November 2013}}</ref><ref>{{cite journal | vauthors = Ford AR, Gibbons CM, Torres J, Kornmehl HA, Singh S, Young PM, Chambers CJ, Maverakis E, Dunnick CA, Armstrong AW | title = Access to Dermatological Care with an Innovative Online Model for Psoriasis Management: Results from a Randomized Controlled Trial | journal = Telemedicine Journal and e-Health | volume = 25 | issue = 7 | pages = 619–627 | date = July 2019 | pmid = 30222518 | pmc = 6417973 | doi = 10.1089/tmj.2018.0160 }}</ref> Applications comprise health care management such as diagnoses, consultation and treatment as well as (continuing medical) education.<ref>{{cite book | vauthors = Wootton R, Batch J |year=2005 |title=Telepediatrics: telemedicine and child health |publisher=Royal Society of Medicine |isbn=978-1-85315-645-8 }}{{page needed|date=June 2018}}</ref><ref>{{cite journal | vauthors = Wurm EM, Hofmann-Wellenhof R, Wurm R, Soyer HP | title = Telemedicine and teledermatology: Past, present and future | journal = Journal der Deutschen Dermatologischen Gesellschaft | volume = 6 | issue = 2 | pages = 106–112 | date = February 2008 | pmid = 18005076 | doi = 10.1111/j.1610-0387.2007.06440.x }}</ref><ref>{{cite journal | vauthors = Burg G, Hasse U, Cipolat C, Kropf R, Djamei V, Soyer HP, Chimenti S | title = Teledermatology: just cool or a real tool? | journal = Dermatology | volume = 210 | issue = 2 | pages = 169–173 | year = 2005 | pmid = 15724100 | doi = 10.1159/000082573 }}</ref> The dermatologists Perednia and Brown were the first to coin the term ''teledermatology'' in 1995, where they described the value of a teledermatologic service in a rural area underserved by dermatologists.<ref>{{cite journal | vauthors = Perednia DA, Brown NA | title = Teledermatology: one application of telemedicine | journal = Bulletin of the Medical Library Association | volume = 83 | issue = 1 | pages = 42–47 | date = January 1995 | pmid = 7703938 | pmc = 225996 }}</ref>

=== Teleophthalmology ===
{{main|Teleophthalmology}}
Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology. Today, applications of teleophthalmology encompass access to eye specialists for patients in remote areas, ophthalmic disease screening, diagnosis and monitoring; as well as distant learning. Teleophthalmology may help reduce disparities by providing remote, low-cost screening tests such as diabetic retinopathy screening to low-income and uninsured patients.<ref>{{cite web |publisher=Agency for Healthcare Research and Quality |url=https://innovations.ahrq.gov/profiles/telemedicine-based-eye-examinations-enhance-access-reduce-costs-and-increase-satisfaction |title=Telemedicine-Based Eye Examinations Enhance Access, Reduce Costs, and Increase Satisfaction for Low-Income and Minority Patients with Diabetes |date=2013-07-17 |access-date=24 July 2013}}</ref><ref>{{cite web |publisher=Agency for Healthcare Research and Quality |url=https://innovations.ahrq.gov/profiles/remote-retinal-screening-facilitates-diagnosis-and-treatment-retinopathy-poor-andor |title=Remote Retinal Screening Facilitates Diagnosis and Treatment of Retinopathy for Poor and/or Uninsured Patients With Diabetes in Rural California |date=2012-10-03 |access-date=24 July 2013}}</ref> In Mizoram, India, a hilly area with poor roads, between 2011 and 2015, teleophthalmology provided care to over 10,000 patients. These patients were examined by ophthalmic assistants locally but surgery was done on appointment after the patient images were viewed online by eye surgeons in the hospital 6–12 hours away. Instead of an average five trips for say, a cataract procedure, only one was required for surgery alone as even post-op care like removal of stitches and appointments for glasses was done locally. There were large cost savings in travel as well.<ref>{{cite journal |last1=Phukan |first1=Riki |last2=Mehta |first2=Manoj Rai |last3=Gogia |first3=Shashi |title=Results and Problems in Executing Teleophthalmology |journal=Indian Journal of Medical Informatics |volume=8 |issue=2 |date=2014 |pages=32–33 }}</ref>

In the United States, some companies allow patients to complete an online visual exam and within 24 hours receive a prescription from an optometrist valid for eyeglasses, contact lenses, or both. Some US states such as Indiana have attempted to ban these companies from doing business.<ref name=Alb>{{cite web|title=Telehealth company sues Indiana for ban on online eye exams|work=TimesUnion.com|url=https://www.timesunion.com/news/article/Telehealth-company-sues-Indiana-for-ban-on-online-13783679.php|date=21 April 2019}}</ref>

=== Telesurgery ===
{{main|Remote surgery}}
{{See also|Augmented reality-assisted surgery}}
[[Remote surgery]] (also known as telesurgery) is the ability for a doctor to perform [[surgery]] on a patient even though they are not physically in the same location. It is a form of [[telepresence]]. Remote surgery combines elements of [[robot]]ics, cutting-edge [[telecommunication]]s such as high-speed data connections, [[telehaptics]] and elements of [[management information system]]s. While the field of [[robotic surgery]] is fairly well established, most of these robots are controlled by surgeons at the location of the surgery.

Remote surgery is [[remote work]] for surgeons, where the physical distance between the surgeon and the patient is immaterial. It promises to allow the expertise of specialized surgeons to be available to patients worldwide, without the need for patients to travel beyond their local hospital.<ref>{{Cite web | url=http://www.intersurgtech.com/media.html | title=IST's Media Collection | work=Interface Surgical Technologies}}</ref>

Remote surgery or telesurgery is performance of surgical procedures where the surgeon is not physically in the same location as the patient, using a robotic [[teleoperator]] system controlled by the surgeon. The remote operator may give tactile feedback to the user. Remote surgery combines elements of robotics and high-speed data connections. A critical limiting factor is the speed, [[Latency (engineering)|latency]] and reliability of the communication system between the surgeon and the patient, though trans-Atlantic surgeries have been demonstrated.

=== Teleabortion ===
{{POV|date=December 2020}}
Telemedicine has been used globally to increase access to abortion care, specifically [[medical abortion]], in environments where few abortion care providers exist or abortion is legally restricted. Clinicians are able to virtually provide counseling, review screening tests, observe the administration of an abortion medication, and directly mail abortion pills to people.<ref name="Endler-2019">{{cite journal | vauthors = Endler M, Lavelanet A, Cleeve A, Ganatra B, Gomperts R, Gemzell-Danielsson K | title = Telemedicine for medical abortion: a systematic review | journal = BJOG | volume = 126 | issue = 9 | pages = 1094–1102 | date = August 2019 | pmid = 30869829 | pmc = 7496179 | doi = 10.1111/1471-0528.15684 | doi-access = free }}</ref> In 2004, [[Women on Web]] (WoW), Amsterdam, started offering online consultations, mostly to people living in areas where abortion was legally restricted, informing them how to safely use medical abortion drugs to end a pregnancy.<ref name="Endler-2019" /> People contact the Women on Web service online; physicians review any necessary lab results or ultrasounds, mail [[mifepristone]] and [[misoprostol]] pills to people, then follow up through online communication.<ref>{{Cite web|title=Study: Taking abortion pill at home as safe as in a clinic|url=https://www.nbcnews.com/health/health-news/women-safely-take-abortion-pills-home-online-consult-n760576|website=NBC News|date=17 May 2017 |language=en|access-date=2020-05-18}}</ref> In the United States, [[medical abortion]] was introduced as a telehealth service in Iowa by Planned Parenthood of the Heartland in 2008 to allow a patient at one health facility to communicate via secure video with a health provider at another facility.<ref name="Guttmacher Institute-2019">{{Cite web|title=Improving Access to Abortion via Telehealth|url=https://www.guttmacher.org/gpr/2019/05/improving-access-abortion-telehealth|date=2019-05-07|website=Guttmacher Institute|language=en|access-date=2020-04-21}}</ref> In this model a person seeking abortion care must come to a health facility. An abortion care provider communicates with the person located at another site using clinic-to-clinic videoconferencing to provide medical abortion after screening tests and consultation with clinic staff. In 2018, the website [[Aid Access]] was launched by the founder of Women on Web, [[Rebecca Gomperts]]. It offers a similar service as Women on Web in the United States, but the medications are prescribed to an Indian pharmacy, then mailed to the United States.

The TelAbortion study conducted by Gynuity Health Projects, with special approval from the U.S. Food and Drug Administration (FDA), aims to increase access to medical abortion care without requiring an in-person visit to a clinic.<ref>{{Cite web|title=Telabortion Project|url=https://telabortion.org/about/|access-date=April 26, 2020}}</ref><ref name="Belluck-2020">{{Cite news| vauthors = Belluck P |title=Abortion by Telemedicine: A Growing Option as Access to Clinics Wanes|work=[[The New York Times]]|date=28 April 2020 |url=https://www.nytimes.com/2020/04/28/health/telabortion-abortion-telemedicine.html|access-date=May 5, 2020}}</ref><ref name="Guttmacher Institute-2019" /> This models was expanded during the [[COVID-19 pandemic]] and as of March 2020 exists in 13 U.S. states and has enrolled over 730 people in the study.<ref>{{Cite web|title=Home - Telabortion|url=https://telabortion.org/|website=telabortion.org|access-date=2020-05-11}}</ref><ref name="Belluck-2020" /> The person receives counseling and instruction from an abortion care provider via videoconference from a location of their choice. The medications necessary for the abortion, mifepristone and misoprostol, are mailed directly to the person and they have a follow-up video consultation in 7–14 days. A systematic review of telemedicine abortion has found the practice to be safe, effective, efficient, and satisfactory.<ref name="Endler-2019" />

In the United States, eighteen states require the clinician to be physically present during the administration of medications for abortion which effectively bans telehealth of medication abortion: five states explicitly ban telemedicine for medication abortion, while thirteen states require the prescriber (usually required to be a physician) to be physically present with the patient.<ref>{{cite journal | vauthors = Jones RK, Jerman J | title = Abortion Incidence and Service Availability In the United States, 2014 | journal = Perspectives on Sexual and Reproductive Health | volume = 49 | issue = 1 | pages = 17–27 | date = March 2017 | pmid = 28094905 | pmc = 5487028 | doi = 10.1363/2019.30760 }}</ref><ref>{{Cite web|date=2020-06-08|title=Medication Abortion and Telemedicine: Innovations and Barriers During the COVID-19 Emergency|url=https://www.kff.org/policy-watch/medication-abortion-telemedicine-innovations-and-barriers-during-the-covid-19-emergency/|access-date=2020-08-03|website=KFF|language=en-US}}</ref> In the UK, the Royal College of Obstetricians and Gynecologists approved a no-test protocol for medication abortion, with mifepristone available through a minimal-contact pick-up or by mail.<ref>{{Cite web|title=Coronavirus (COVID-19) infection and abortion care|url=https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-abortion/|access-date=2020-08-03|website=Royal College of Obstetricians & Gynaecologists|language=en-US}}</ref>

===Other specialist care delivery===
Telemedicine can facilitate specialty care delivered by [[primary care physician]]s according to a controlled study of the treatment of [[hepatitis C]].<ref>{{cite journal | vauthors = Arora S, Thornton K, Murata G, Deming P, Kalishman S, Dion D, Parish B, Burke T, Pak W, Dunkelberg J, Kistin M, Brown J, Jenkusky S, Komaromy M, Qualls C | title = Outcomes of treatment for hepatitis C virus infection by primary care providers | journal = The New England Journal of Medicine | volume = 364 | issue = 23 | pages = 2199–2207 | date = June 2011 | pmid = 21631316 | pmc = 3820419 | doi = 10.1056/NEJMoa1009370 }}</ref> Various specialties are contributing to telemedicine, in varying degrees.Other specialist conditions for which telemedicine has been used include perinatal mental health.<ref>{{cite journal |last1=Sun |first1=Yaoyao |last2=Li |first2=Yanyan |last3=Wang |first3=Juan |last4=Chen |first4=Qingyi |last5=Bazzano |first5=Alessandra N |last6=Cao |first6=Fenglin |title=Effectiveness of Smartphone-Based Mindfulness Training on Maternal Perinatal Depression: Randomized Controlled Trial |journal=Journal of Medical Internet Research |date=27 January 2021 |volume=23 |issue=1 |article-number=e23410 |doi=10.2196/23410 |doi-access=free |pmid=33502326 |pmc=7875700 }}</ref>

In light of the COVID-19 pandemic, primary care physicians have relied on telehealth to continue to provide care in outpatient settings.<ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html|title = Healthcare Workers|date = 11 February 2020}}</ref> The transition to virtual health has been beneficial in providing patients access to care (especially care that does not require a physical exam e.g. medication changes, minor health updates) and avoid putting patients at risk of COVID-19. This included providing services to pediatric patients during the pandemic, where issues of last minute cancelation and rescheduling were frequently related to a lack of technicality and engagement, two factors often understudied in the literature.<ref>{{cite journal |last1=Sezgin |first1=Emre |last2=Huang |first2=Yungui |last3=Lin |first3=Deborah |last4=Ramtekkar |first4=Ujjwal |last5=Pauline |first5=Lindsey |last6=Lin |first6=Simon |title=Documented Reasons of Cancellation and Rescheduling of Telehealth Appointments During the Pandemic |journal=Telemedicine and e-Health |date=October 2021 |volume=27 |issue=10 |pages=1143–1150 |doi=10.1089/tmj.2020.0454 |pmid=33373553 }}</ref>

Telemedicine has also been beneficial in facilitating medical education to students while still allowing for adequate social distancing during the COVID-19 pandemic. Many medical schools have shifted to alternate forms of virtual curriculum and are still able to engage in meaningful telehealth encounters with patients.<ref>{{cite report |type=Preprint |doi=10.35542/osf.io/9urcd |title=Designing Virtual Medical Student Ambulatory Rotations in Light of the Coronavirus Pandemic: A Pilot Project |last1=Louis |first1=Shreya |last2=Isaacson |first2=J. Harry |last3=Yepes-Rios |first3=Monica |last4=Mehta |first4=Neil }}</ref><ref>{{cite web | vauthors = Murphy B | date = 17 September 2020 | title = How Medical Students are Innovating During COVID-19 | url = https://www.ama-assn.org/residents-students/medical-school-life/how-medical-students-are-innovating-during-covid-19 | publisher = American Medical Association }}</ref>

Medication assisted treatment (MAT) is the treatment of [[opioid use disorder]] (OUD) with medications, often in combination with behavioral therapy<ref name="Medication Assisted Treatment (MAT)">{{cite web |title=Information on Medication-Assisted Treatment (MAT) |url=https://www.samhsa.gov/medication-assisted-treatment |website=SAMHSA|date=21 July 2015 }}</ref> As a response to the COVID-19 pandemic the use of telemedicine has been granted by the [[Drug Enforcement Administration]] to start or maintain people OUD on [[buprenorphine]] (trade name Suboxone) via [[telemedicine]] without the need for an initial in-person examination.<ref>{{cite web |title=Use of Telephone Evaluations to Initiate Buprenorphine Prescribing |url=https://www.deadiversion.usdoj.gov/GDP/(DEA-DC-022)(DEA068)%20DEA%20SAMHSA%20buprenorphine%20telemedicine%20%20(Final)%20+Esign.pdf |website=DEA Information Page}}</ref> On March 31, 2020, [[QuickMD]] became the first national [[TeleMAT]] service in the United States to provide Medication-assisted Treatment with Suboxone online – without the need of an in-person visit; with others announcing to follow soon.<ref>{{Cite web |last=Jane |date=2020-07-21 |title=I am Addicted to Opioids and in my Desperation I Turned to the Internet — Here is What happened |url=https://medium.com/@jane1/how-i-beat-my-opioid-addiction-online-suboxone-quickmd-telemat-medication-assisted-treatment-buprenorphine-7d459d14f59e |access-date=2020-07-22 |website=Medium |language=en}}</ref>

== Major developments ==

=== In policy ===
Telehealth is a modern form of health care delivery. Telehealth breaks away from traditional health care delivery by using modern telecommunication systems including wireless communication methods.<ref>{{cite thesis |last1=Altharthi |first1=Mansour Saeed |title=Telehealth practice in eight countries : New Zealand, Australia, the USA, Canada, UK, Malaysia, China and India: a thesis presented in partial fulfillment of the requirements of degree of Master in Information Science at Massey University, Albany campus, Auckland, New Zealand |date=2012 |hdl=10179/3538 |hdl-access=free |oclc=1085527078 }}{{pn|date=July 2025}}</ref><ref name="García-Rojo-2016">{{cite journal | vauthors = García-Rojo M | title = International Clinical Guidelines for the Adoption of Digital Pathology: A Review of Technical Aspects | journal = Pathobiology | volume = 83 | issue = 2–3 | pages = 99–109 | pmid = 27100834 | doi = 10.1159/000441192 | year = 2016 | doi-access = free }}</ref> Traditional health is legislated through policy to ensure the safety of medical practitioners and patients. Consequently, since telehealth is a new form of health care delivery that is now gathering momentum in the health sector, many organizations have started to legislate the use of telehealth into policy.<ref name="García-Rojo-2016" /> In New Zealand, the Medical Council has a statement about telehealth on their website. This illustrates that the medical council has foreseen the importance that telehealth will have on the health system and have started to introduce telehealth legislation to practitioners along with government.<ref>{{cite web |url= https://www.mcnz.org.nz/assets/News-and-Publications/Statement-on-telehealthv3.pdf |title=Statement on telehealth | date=2013 |publisher=Medical Council of New Zealand }}</ref>

=== Transition to mainstream ===
{{See also|Remote patient monitoring}}

Traditional use of telehealth services has been for specialist treatment. However, there has been a paradigm shift and telehealth is no longer considered a specialist service.<ref>{{cite thesis |last1=Lucas |first1=Julie Anne |title=Clinicians' Perceptions of Telemedicine: Opportunities and Barriers for Emergency Medicine |date=2013 |hdl=2292/20430 |hdl-access=free }}{{pn|date=July 2025}}</ref> This development has ensured that many access barriers are eliminated, as medical professionals and patients are able to use wireless communication technologies to deliver health care.<ref name="Bazzano-2024">{{Cite journal |last1=Bazzano |first1=Alessandra N. |last2=Patel |first2=Tejal |last3=Nauman |first3=Elizabeth |last4=Cernigliaro |first4=Dana |last5=Shi |first5=Lizheng |date=2024-01-01 |title=Optimizing Telehealth for Diabetes Management in the Deep South of the United States: Qualitative Study of Barriers and Facilitators on the Patient and Clinician Journey |journal=Journal of Medical Internet Research |language=EN |volume=26 |issue=1 |article-number=e43583 |doi=10.2196/43583|doi-access=free |pmid=37976468 |pmc=10790202 }}</ref> This is evident in [[Rural health|rural communities]]. Rural residents typically have to travel to longer distances to access healthcare than urban counterparts due to physician shortages and healthcare facility closures in these areas.<ref>{{Cite web |title=Transportation to Support Rural Healthcare Overview - Rural Health Information Hub |url=https://www.ruralhealthinfo.org/topics/transportation#travel-burdens |access-date=2024-04-14 |website=www.ruralhealthinfo.org |language=en}}</ref><ref>{{Cite web |title=Healthcare Access in Rural Communities Overview - Rural Health Information Hub |url=https://www.ruralhealthinfo.org/topics/healthcare-access |access-date=2024-04-14 |website=www.ruralhealthinfo.org |language=en}}</ref> Telehealth eliminates this barrier as health professionals are able to conduct medical consultations through the use of wireless communication technologies. However, this process is dependent on both parties having internet access and comfort level with technology, which poses barriers for many low-income and rural communities.<ref name="Bazzano-2024" /><ref>{{cite journal | vauthors = Possemato K, Bishop TM, Willis MA, Lantinga LJ | title = Healthcare utilization and symptom variation among veterans using Behavioral Telehealth Center services | journal = The Journal of Behavioral Health Services & Research | volume = 40 | issue = 4 | pages = 416–26 | date = October 2013 | pmid = 23616251 | doi = 10.1007/s11414-013-9338-y }}</ref><ref>{{cite journal | vauthors = Darkins A, Foster L, Anderson C, Goldschmidt L, Selvin G | title = The design, implementation, and operational management of a comprehensive quality management program to support national telehealth networks | journal = Telemedicine Journal and e-Health | volume = 19 | issue = 7 | pages = 557–64 | date = July 2013 | pmid = 23705961 | doi = 10.1089/tmj.2012.0263 }}</ref><ref>{{Cite web |title=Telehealth and Health Information Technology in Rural Healthcare Overview - Rural Health Information Hub |url=https://www.ruralhealthinfo.org/topics/telehealth-health-it#:~:text=Challenges%20for%20providing%20telehealth%20services,and%20access%20to%20broadband%20services. |access-date=2024-04-14 |website=www.ruralhealthinfo.org |language=en}}</ref>

Telehealth allows the patient to be monitored between physician office visits which can improve patient health. Telehealth also allows patients to access expertise which is not available in their local area. This remote patient monitoring ability enables patients to stay at home longer and helps avoid unnecessary hospital time. In the long-term, this could potentially result in less burdening of the healthcare system and consumption of resources.<ref name="Office for the Advancement of Telehealth-2022" /><ref name="Maheu-2002" />

During the COVID-19 pandemic, there were large increases in the use of telemedicine for primary care visits within the United States, increasing from an average of 1.4 million visits in Q2 of 2018 and 2019 to 35 million visits in Q2 2020, according to data from [[IQVIA]].<ref>{{cite journal | vauthors = Alexander GC, Tajanlangit M, Heyward J, Mansour O, Qato DM, Stafford RS | title = Use and Content of Primary Care Office-Based vs Telemedicine Care Visits During the COVID-19 Pandemic in the US | journal = JAMA Network Open | volume = 3 | issue = 10 | pages = e2021476 | date = October 2020 | pmid = 33006622 | pmc = 7532385 | doi = 10.1001/jamanetworkopen.2020.21476 }}</ref> The telehealth market is expected to grow at 40% a year in 2021. Use of telemedicine by General Practitioners in the UK rose from 20 to 30% pre-COVID to almost 80% by the beginning of 2021. More than 70% of practitioners and patients were satisfied with this.<ref>{{cite news |title=Telemedicine is here to stay |url=https://www.buildingbetterhealthcare.com/news/article_page/Telemedicine_is_here_to_stay/178218/cn164706 |access-date=26 September 2021 |publisher=Building Better Healthcare |date=11 August 2021}}</ref> [[Boris Johnson]] was said to have "piled pressure on GPs to offer more in-person consultations" supporting a campaign largely orchestrated by the ''[[Daily Mail]]''. The [[Royal College of General Practitioners]] said that a patient "right" to have face-to-face appointments if they wished was "undeliverable".<ref>{{cite news |title=Prime Minister says GPs should see patients face to face |url=https://www.pulsetoday.co.uk/news/breaking-news/prime-minister-says-gps-should-see-patients-face-to-face/ |access-date=26 September 2021 |publisher=Pulse |date=21 September 2021}}</ref>

=== Technology advancement ===
{{See also|Technology|Emerging technologies}}

The technological advancement of wireless communication devices is a major development in telehealth.<ref name="Vockley-2015">{{cite journal | vauthors = Vockley M | title = The Rise of Telehealth: 'Triple Aim,' Innovative Technology, and Popular Demand Are Spearheading New Models of Health and Wellness Care | journal = Biomedical Instrumentation & Technology | volume = 49 | issue = 5 | pages = 306–20 | date = 2015-10-01 | pmid = 26443907 | doi = 10.2345/0899-8205-49.5.306 }}</ref> This allows patients to self-monitor their health conditions and to not rely as much on health care professionals. Furthermore, patients are more willing to stay on their treatment plans as they are more invested and included in the process as the decision-making is shared.<ref name="Kvedar-2014">{{cite journal | vauthors = Kvedar J, Coye MJ, Everett W | title = Connected health: a review of technologies and strategies to improve patient care with telemedicine and telehealth | journal = Health Affairs | volume = 33 | issue = 2 | pages = 194–9 | date = February 2014 | pmid = 24493760 | doi = 10.1377/hlthaff.2013.0992 | doi-access = free }}</ref><ref name="Hirani-2017">{{cite journal |last1=Hirani |first1=Shashivadan P |last2=Rixon |first2=Lorna |last3=Beynon |first3=Michelle |last4=Cartwright |first4=Martin |last5=Cleanthous |first5=Sophie |last6=Selva |first6=Abi |last7=Sanders |first7=Caroline |last8=Newman |first8=Stanton P |last9=WSD |first9=investigators |title=Quantifying beliefs regarding telehealth: Development of the Whole Systems Demonstrator Service User Technology Acceptability Questionnaire |journal=Journal of Telemedicine and Telecare |date=May 2017 |volume=23 |issue=4 |pages=460–469 |doi=10.1177/1357633X16649531 |pmid=27224997 }}</ref> Technological advancement also means that health care professionals are able to use better technologies to treat patients for example in maternal care<ref>{{cite journal | vauthors = Cantor AG, Jungbauer RM, Totten AM, Tilden EL, Holmes R, Ahmed A, Wagner J, Hermesch AC, McDonagh MS | title = Telehealth Strategies for the Delivery of Maternal Health Care: A Rapid Review | journal = Annals of Internal Medicine | volume = 175 | issue = 9 | pages = 1285–1297 | date = September 2022 | pmid = 35878405 | doi = 10.7326/M22-0737 }}</ref> and [[surgery]]. A 2023 study published in the ''[[Journal of the American College of Surgeons]]'' showed telemedicine as making a positive impact, with expectations exceeded for those physicians and patients who had consulted online for surgeries.<ref>{{cite web|url=https://www.medicaleconomics.com/view/telemedicine-better-than-expected-for-consulting-on-surgeries|author=Richard Payerchin|title=Telemedicine better than expected for consulting on surgeries|website=Medical Economics|date=January 20, 2023}}</ref> Technological developments in telehealth are essential to improve health care, especially the delivery of healthcare services, as resources are finite along with an ageing population that is living longer.<ref name="Vockley-2015" /><ref name="Kvedar-2014" /><ref name="Hirani-2017" />

== Licensing ==
=== U.S. licensing and regulatory issues ===
Restrictive licensure laws in the United States require a practitioner to obtain a full license to deliver telemedicine care across state lines. Typically, states with restrictive licensure laws also have several exceptions (varying from state to state) that may release an out-of-state practitioner from the additional burden of obtaining such a license. A number of states require practitioners who seek compensation to frequently deliver interstate care to acquire a full license.

If a practitioner serves several states, obtaining this license in each state could be an expensive and time-consuming proposition. Even if the practitioner never practices medicine face-to-face with a patient in another state, he/she still must meet a variety of other individual state requirements, including paying substantial licensure fees, passing additional oral and written examinations, and traveling for interviews.

In 2008, the U.S. passed the Ryan Haight Act which required face-to-face or valid telemedicine consultations prior to receiving a prescription.<ref>{{cite web|url=http://www.govtech.com/health/Ryan-Haight-Act-will.html|title=Ryan Haight Act will Require Tighter Restrictions on Internet Pharmacies|website=www.govtech.com|date=27 July 2010|access-date=7 March 2016}}</ref>

[[:Category:Medical licensing boards in the United States|State medical licensing boards]] have sometimes opposed telemedicine; for example, in 2012 electronic consultations were illegal in Idaho, and an Idaho-licensed general practitioner was punished by the board for prescribing an antibiotic, triggering reviews of her licensure and board certifications across the country.<ref name=":0b">{{cite web|url=http://www.spokesman.com/stories/2015/aug/22/telemedicine-sanction-in-idaho-clouds-doctors/|title=Telemedicine sanction in Idaho clouds doctor's future|website=Spokesman.com|access-date=7 March 2016}}</ref> Subsequently, in 2015 the state legislature legalized electronic consultations.<ref name=":0b" />

In 2015, Teladoc filed suit against the [[Texas Medical Board]] over a rule that required in-person consultations initially; the judge refused to dismiss the case, noting that antitrust laws apply to state medical boards.<ref>{{cite web|url=http://www.modernhealthcare.com/article/20151214/NEWS/151219924|title=Teladoc case against Texas Medical Board will move forward, judge rules|website=Modern Healthcare|date=14 December 2015|access-date=7 March 2016}}</ref>

== Major implications and impacts ==
Telehealth allows multiple, varying disciplines to merge and deliver a potentially more uniform level of care, using technology. As telehealth proliferates mainstream healthcare, it challenges notions of traditional healthcare delivery. Some populations experience better quality, access and more personalized health care.<ref name="Elsevier-2012">{{Cite book|title=Telemental Health: Clinical, Technical, and Administrative Foundations for Evidence-Based Practice|date=2012-09-20|publisher=Elsevier|isbn=978-0-12-416048-4 | veditors = Myers K, Turvey C |edition=1  }}</ref><ref name="Umefjord-2006">{{cite thesis |last1=Umefjord |first1=Göran |title=Internet consultation in medicine: studies of a text-based Ask the doctor service |date=2006 |url=https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-854 }}{{pn|date=July 2025}}</ref>

=== Health promotion ===
{{See also|Health promotion}} [[File:SmallWorldSocial BreastfeedingSupportProject GeorgiawithBabyEve.jpg|thumb|Baby Eve with Georgia for the Breastfeeding Support Project]]Telehealth can also increase health promotion efforts. These efforts can now be more personalised to the target population and professionals can extend their help into homes or private and safe environments in which patients of individuals can practice, ask and gain health information.<ref name="Maheu-2002" /><ref name="Hirani-2017" /><ref>{{cite journal | vauthors = Kahn JM | title = Virtual visits--confronting the challenges of telemedicine | journal = The New England Journal of Medicine | volume = 372 | issue = 18 | pages = 1684–1685 | date = April 2015 | pmid = 25923547 | doi = 10.1056/NEJMp1500533 }}</ref> Health promotion using telehealth has become increasingly popular in [[Developing country|underdeveloped countries]] where there are very poor physical resources available. There has been a particular push toward [[mHealth]] applications as many areas, even underdeveloped ones have mobile phone and smartphone coverage.<ref>{{cite book |last1=Goggin |first1=Gerard |title=Cell Phone Culture: Mobile Technology in Everyday Life |date=2006 |publisher=Routledge |isbn=978-0-415-36743-1 }}{{pn|date=July 2025}}</ref><ref>{{cite book |last1=Donner |first1=Jonathan |last2=Mechael |first2=Patricia |title=MHealth in Practice: Mobile Technology for Health Promotion in the Developing World |date=2013 |publisher=A&C Black |isbn=978-1-78093-229-3 }}{{pn|date=July 2025}}</ref><ref>{{cite journal | vauthors = Ben-Zeev D, Brian RM, Jonathan G, Razzano L, Pashka N, Carpenter-Song E, Drake RE, Scherer EA | title = Mobile Health (mHealth) Versus Clinic-Based Group Intervention for People With Serious Mental Illness: A Randomized Controlled Trial | journal = Psychiatric Services | volume = 69 | issue = 9 | pages = 978–985 | date = September 2018 | pmid = 29793397 | doi = 10.1176/appi.ps.201800063 | doi-access = free }}</ref>

In a 2015 article reviewing research on the use of a mobile health application in the United Kingdom,<ref>{{cite journal | vauthors = Hardinge M, Rutter H, Velardo C, Shah SA, Williams V, Tarassenko L, Farmer A | title = Using a mobile health application to support self-management in chronic obstructive pulmonary disease: a six-month cohort study | journal = BMC Medical Informatics and Decision Making | volume = 15 | issue = 1 | article-number = 46 | date = June 2015 | pmid = 26084626 | pmc = 4472616 | doi = 10.1186/s12911-015-0171-5 | doi-access = free }}</ref> authors describe how a home-based application helped patients manage and monitor their health and symptoms independently. The mobile health application allows people to rapidly self-report their symptoms – 95% of patients were able to report their daily symptoms in less than 100 seconds, which is less than the 5 minutes (plus commuting) taken to measure vital signs by nurses in hospitals.<ref>{{cite journal | vauthors = Dall'Ora C, Griffiths P, Hope J, Briggs J, Jeremy J, Gerry S, Redfern OC | title = How long do nursing staff take to measure and record patients' vital signs observations in hospital? A time-and-motion study | journal = International Journal of Nursing Studies | volume = 118 | article-number = 103921 | date = June 2021 | pmid = 33812297 | pmc = 8249906 | doi = 10.1016/j.ijnurstu.2021.103921 }}</ref> Online applications allow patients to remain at home to keep track of the progression of their chronic illnesses. The downside of using mHealth applications is that not everyone, especially in developing countries, has daily access to internet or electronic devices.<ref>{{Cite web |date=2021-11-29 |title=Facts and Figures 2021: 2.9 billion people still offline |url=https://www.itu.int/hub/2021/11/facts-and-figures-2021-2-9-billion-people-still-offline/ |access-date=2022-05-10 |website=ITU Hub |language=en-US}}</ref>

In [[Developed country|developed countries]], health promotion efforts using telehealth have been met with some success. The [[Google Glass breastfeeding app trial|Australian hands-free breastfeeding Google Glass application]] reported promising results in 2014. This application made in collaboration with the Australian Breastfeeding Association and a tech startup called [[Small World Social]], helped new mothers learn how to [[Breastfeeding|breastfeed]].<ref>{{Cite web|url=http://www.hlntv.com/article/2014/04/23/breastfeeding-google-glass-app?sr=fb042414breastfeed10photolink|title=Google Glass can help you breastfeed | date=2014|publisher=HLN Staff}}</ref><ref>{{Cite web|url=https://www.breastfeeding.asn.au/breastfeeding-and-google-glass-application-trial|title=Breastfeeding and Google Glass application trial|date=2016|publisher=The Australian Breastfeeding Association|access-date=2016-06-16|archive-date=2019-04-10|archive-url=https://web.archive.org/web/20190410075803/https://www.breastfeeding.asn.au/breastfeeding-and-google-glass-application-trial}}</ref><ref name="SWS Website-2015">{{Cite web|url=https://www.smallworldsocial.com/breastfeeding-support-project/|title=Breastfeeding Support Program Through Google Glass |work=SWS Website | date=2015|publisher=Small World}}</ref> Breastfeeding is beneficial to infant health and [[maternal health]] and is recommended by the [[World Health Organization|World Health Organisation]] and health organisations all over the world.<ref>{{cite book |last1=Horta |first1=Bernardo L. |last2=Bahl |first2=Rajiv |last3=Martinés |first3=José Carlos |last4=Victora |first4=Cesar G. |last5=Organization |first5=World Health |title=Evidence on the long-term effects of breastfeeding: systematic review and meta-analyses. |date=2007 |publisher=World Health Organization |isbn=978-92-4-159523-0 |hdl=10665/43623 |hdl-access=free }}{{pn|date=July 2025}}</ref><ref name="Victora-2016">{{cite journal | vauthors = Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC | title = Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect | journal = Lancet | volume = 387 | issue = 10017 | pages = 475–490 | date = January 2016 | pmid = 26869575 | doi = 10.1016/S0140-6736(15)01024-7 | doi-access = free | hdl = 10072/413175 | hdl-access = free }}</ref> Widespread breastfeeding can prevent 820,000 infant deaths globally but the practice is often stopped prematurely or intents to do are disrupted due to lack of social support, know-how or other factors.<ref name="Victora-2016" /> This application gave mother's hands-free information on breastfeeding, instructions on how to breastfeed and also had an option to call a lactation consultant over Google Hangout. When the trial ended, all participants were reported to be confident in breastfeeding.<ref name="SWS Website-2015" />

=== Health care quality and barriers to adoption ===
{{See also|Health care quality}}

A [[scientific review]] indicates that, in general, outcomes of telemedicine are or can be as good as in-person care with health care use staying similar.<ref>{{cite journal | vauthors = Albritton J, Ortiz A, Wines R, Booth G, DiBello M, Brown S, Gartlehner G, Crotty K | title = Video Teleconferencing for Disease Prevention, Diagnosis, and Treatment: A Rapid Review | journal = Annals of Internal Medicine | volume = 175 | issue = 2 | pages = 256–266 | date = February 2022 | pmid = 34871056 | doi = 10.7326/m21-3511 }}</ref>

[[File:Diagnosis By Radio, 1925 (telemedicine).webp|thumb|Telemedicine as predicted in 1925<ref>{{cite web | vauthors = Novak M |title=Telemedicine Predicted in 1925 |url=https://www.smithsonianmag.com/history/telemedicine-predicted-in-1925-124140942/ |website=Smithsonian Magazine |access-date=1 February 2022 |language=en}}</ref>]]
Advantages of the nonexclusive adoption of already existing telemedicine technologies such as smartphone [[videotelephony]] may include reduced infection risks,<ref name="COVID-19 Reducing the Risks: Teleme">{{cite journal | vauthors = Gillman-Wells CC, Sankar TK, Vadodaria S | title = COVID-19 Reducing the Risks: Telemedicine is the New Norm for Surgical Consultations and Communications | journal = Aesthetic Plastic Surgery | volume = 45 | issue = 1 | pages = 343–348 | date = February 2021 | pmid = 32885319 | pmc = 7471549 | doi = 10.1007/s00266-020-01907-8 }}</ref> increased control of disease during epidemic conditions,<ref>{{cite journal | vauthors = Monaghesh E, Hajizadeh A | title = The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence | journal = BMC Public Health | volume = 20 | issue = 1 | article-number = 1193 | date = August 2020 | pmid = 32738884 | pmc = 7395209 | doi = 10.1186/s12889-020-09301-4 | doi-access = free }}</ref> improved access to care,<ref name="aafp-tele">{{cite web |title=Telehealth Key to Maintaining Access to Addiction Recovery |url=https://www.aafp.org/news/opinion/20220111guested-telemedsud.html |website=www.aafp.org |access-date=27 January 2022}}</ref> reduced stress and exposure to other pathogens<ref name="10.1016/j.jaip.2020.03.008">{{cite journal | vauthors = Portnoy J, Waller M, Elliott T | title = Telemedicine in the Era of COVID-19 | journal = The Journal of Allergy and Clinical Immunology. In Practice | volume = 8 | issue = 5 | pages = 1489–1491 | date = May 2020 | pmid = 32220575 | pmc = 7104202 | doi = 10.1016/j.jaip.2020.03.008 }}</ref><ref>{{cite web |title=Benefits of Telemedicine |url=https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/Benefits-of-Telemedicine |website=www.hopkinsmedicine.org |date=18 January 2022 |access-date=1 February 2022 |language=en}}</ref> during illness for better recovery, reduced time<ref>{{cite journal | vauthors = Molfenter T, Boyle M, Holloway D, Zwick J | title = Trends in telemedicine use in addiction treatment | journal = Addiction Science & Clinical Practice | volume = 10 | issue = 1 | article-number = 14 | date = May 2015 | pmid = 26016484 | pmc = 4636787 | doi = 10.1186/s13722-015-0035-4 | doi-access = free }}</ref> and labor costs, efficient more accessible matching of patients with particular symptoms and clinicians who are experts for such, and reduced travel while disadvantages may include privacy breaches (e.g. due to software backdoors and vulnerabilities or sale of data), dependability on Internet access<ref name="COVID-19 Reducing the Risks: Teleme"/> and, depending on various factors, increased health care use.{{additional citation needed|date=January 2022}}

Theoretically, the whole health system could benefit from telehealth. There are indications telehealth consumes fewer resources and requires fewer people to operate it with shorter training periods to implement initiatives.<ref name="The Center for Connected Health Policy" /> Commenters suggested that lawmakers may fear that making telehealth widely accessible, without any other measures, would lead to patients using unnecessary health care services.<ref name="aafp-tele"/> Telemedicine could also be used for connected networks between health care professionals.<ref>{{cite journal | vauthors = Hyder MA, Razzak J | title = Telemedicine in the United States: An Introduction for Students and Residents | journal = Journal of Medical Internet Research | volume = 22 | issue = 11 | article-number = e20839 | date = November 2020 | pmid = 33215999 | pmc = 7690251 | doi = 10.2196/20839 | doi-access = free }}</ref>

Telemedicine also can eliminate the possible transmission of [[infectious disease]]s or [[parasite]]s between patients and medical staff. This is particularly an issue where [[MRSA]] is a concern. Additionally, some patients who feel uncomfortable in a doctors office may do better remotely. For example, [[white coat syndrome]] may be avoided. Patients who are home-bound and would otherwise require an ambulance to move them to a clinic are also a consideration.

However, whether or not the standard of health care quality is increasing is debatable, with some literature refuting such claims.<ref name="Umefjord-2006" /><ref name="Bardsley-2013">{{cite journal | vauthors = Bardsley M, Steventon A, Doll H | title = Impact of telehealth on general practice contacts: findings from the whole systems demonstrator cluster randomised trial | journal = BMC Health Services Research | volume = 13 | article-number = 395 | date = October 2013 | pmid = 24099334 | pmc = 3852608 | doi = 10.1186/1472-6963-13-395 | doi-access = free }}</ref><ref name="pmid23444424">{{cite journal | vauthors = Cartwright M, Hirani SP, Rixon L, Beynon M, Doll H, Bower P, Bardsley M, Steventon A, Knapp M, Henderson C, Rogers A, Sanders C, Fitzpatrick R, Barlow J, Newman SP | title = Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial | journal = BMJ | volume = 346 | pages = f653 | date = February 2013 | pmid = 23444424 | pmc = 3582704 | doi = 10.1136/bmj.f653 }}</ref> Research has reported that clinicians find the process difficult and complex to deal with.<ref name="Bardsley-2013" /><ref name="pmid22834978">{{cite journal | vauthors = Sanders C, Rogers A, Bowen R, Bower P, Hirani S, Cartwright M, Fitzpatrick R, Knapp M, Barlow J, Hendy J, Chrysanthaki T, Bardsley M, Newman SP | title = Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study | journal = BMC Health Services Research | volume = 12 | article-number = 220 | date = July 2012 | pmid = 22834978 | pmc = 3413558 | doi = 10.1186/1472-6963-12-220 | doi-access = free }}</ref> Furthermore, there are concerns around informed consent, legality issues as well as legislative issues. A recent study also highlighted that the swift and large-scale implementation of telehealth across the United Kingdom NHS Allied Health Professional (AHP) services might increase disparities in health care access for vulnerable populations with limited digital literacy.<ref>{{cite journal | vauthors = Eddison N, Leone E, Healy A, Royse C, Chockalingam N | title = The potential impact of allied health professional telehealth consultations on health inequities and the burden of treatment | journal = International Journal for Equity in Health | volume = 21 | issue = 1 | article-number = 91 | date = June 2022 | pmid = 35773695 | pmc = 9245876 | doi = 10.1186/s12939-022-01689-2 | doi-access = free }}</ref> Although health care may become affordable with the help of technology, whether or not this care will be "good" is the issue.<ref name="Umefjord-2006" /> Many studies indicate high satisfaction with telemedicine among patients.<ref>{{cite journal | vauthors = Waller M, Stotler C | title = Telemedicine: a Primer | journal = Current Allergy and Asthma Reports | volume = 18 | issue = 10 | article-number = 54 | date = August 2018 | pmid = 30145709 | doi = 10.1007/s11882-018-0808-4 }}</ref> Among the factors associated with a good trust in telemedicine, the use of known and user-friendly video services and confidence in the [[Information privacy|data protection]] policies were the two variables contributing most to trust in telemedicine.<ref>{{cite journal |last1=Costantino |first1=Andrea |last2=Caprioli |first2=Flavio |last3=Elli |first3=Luca |last4=Roncoroni |first4=Leda |last5=Stocco |first5=Davide |last6=Doneda |first6=Luisa |last7=Nandi |first7=Nicoletta |last8=Conforti |first8=Francesco Simone |last9=Noviello |first9=Daniele |last10=Penagini |first10=Roberto |last11=Vecchi |first11=Maurizio |title=Determinants of patient trust in gastroenterology televisits: Results of machine learning analysis |journal=Informatics in Medicine Unlocked |date=2022 |volume=29 |article-number=100867 |doi=10.1016/j.imu.2022.100867 }}</ref>

Major problems with increasing adoption include technically challenged staff, resistance to change or habits<ref name="10.1016/j.jaip.2020.03.008"/> and age of patient. Focused policy could eliminate several barriers.<ref>{{cite journal | vauthors = Scott Kruse C, Karem P, Shifflett K, Vegi L, Ravi K, Brooks M | title = Evaluating barriers to adopting telemedicine worldwide: A systematic review | journal = Journal of Telemedicine and Telecare | volume = 24 | issue = 1 | pages = 4–12 | date = January 2018 | pmid = 29320966 | pmc = 5768250 | doi = 10.1177/1357633X16674087 }}</ref>

A review lists a number of potentially good practices and pitfalls, recommending the use of "virtual handshakes" for [[authentication|confirming identity]], taking consent for conducting remote consultation over a conventional meeting, and professional standardized norms for protecting patient privacy and confidentiality.<ref name="10.1016/j.dsx.2020.06.007">{{cite journal | vauthors = Iyengar K, Jain VK, Vaishya R | title = Pitfalls in telemedicine consultations in the era of COVID 19 and how to avoid them | journal = Diabetes & Metabolic Syndrome | volume = 14 | issue = 5 | pages = 797–799 | date = 1 September 2020 | pmid = 32534432 | pmc = 7280804 | doi = 10.1016/j.dsx.2020.06.007 }}</ref> It also found that the [[COVID-19 pandemic]] substantially increased, voluntarily, the adoption of telephone or video consultation and suggests that telemedicine technology "is a key factor in delivery of health care in the future".<ref name="10.1016/j.dsx.2020.06.007"/>

=== Geriatric population ===

Technologies' growing involvement in health care has led to continuous improvement in access, efficiency and quality of care, but numerous challenges lie with addressing the barriers that impair the geriatric population from benefitting from the use of this new technology.<ref>{{cite journal |last1=Alverson |first1=Dale C. |last2=Krupinski |first2=Elizabeth A. |last3=Erps |first3=Kristine A. |last4=Rowe |first4=Nancy S. |last5=Weinstein |first5=Ronald S. |title=The Third National Telemedicine & Telehealth Service Provider Showcase Conference: Advancing Telehealth Partnerships |journal=Telemedicine and e-Health |date=April 2019 |volume=25 |issue=4 |pages=332–340 |doi=10.1089/tmj.2018.0096 |pmid=29851367 |pmc=6482893 }}</ref> With the COVID-19 pandemic, rapid implementation of telehealth in geriatric outpatient clinics occurred. Although time efficiency greatly improved and increased access to geriatric patients with lack of transportation to the clinic, there were complications that arose during and after implementation with many appointments requiring rescheduling due to language barrier, poor connection, hard of hearing, or inability to perform assessments.<ref>{{cite journal |last1=Callisaya |first1=Michele L. |last2=Lee |first2=Angel Hui-Ching |last3=Khushu |first3=Anjali |title=Rapid implementation of telehealth in geriatric outpatient clinics due to COVID-19 |journal=Internal Medicine Journal |date=July 2021 |volume=51 |issue=7 |pages=1151–1155 |doi=10.1111/imj.15306 |pmid=34143563 |pmc=8444941 }}</ref> Studies also show that patients and their family member often preferred in-person visits. Even though patients were able to meet with a provider sooner and had access to high-quality audio and video as well as family participation during visits, patients and family noted preferences for in-person visits due to the difficulty in using the service.<ref>{{cite journal |last1=Groom |first1=Lisa L. |last2=McCarthy |first2=Margaret M. |last3=Stimpfel |first3=Amy Witkoski |last4=Brody |first4=Abraham A. |title=Telemedicine and Telehealth in Nursing Homes: An Integrative Review |journal=Journal of the American Medical Directors Association |date=September 2021 |volume=22 |issue=9 |pages=1784–1801.e7 |doi=10.1016/j.jamda.2021.02.037 |pmid=33819450 |pmc=9626369 }}</ref> Improvements are being made to help ease the complications of telehealth for geriatric patients. These include integrated captions on video calls for the hearing impaired, virtual interpreters that will attend the calls for language differences, government assisted internet services, and increased training to medical providers and patients on telehealth use.{{citation needed|date=September 2025}}

=== Economic evaluations ===
Due to its digital nature, it is often assumed that telehealth saves the health system money. However, the evidence to support this is varied. When conducting economic evaluations of telehealth services, the individuals evaluating them need to be aware of potential outcomes and extraclinical benefits of the telehealth service.<ref>{{cite journal | vauthors = Snoswell C, Smith AC, Scuffham PA, Whitty JA | title = Economic evaluation strategies in telehealth: Obtaining a more holistic valuation of telehealth interventions | journal = Journal of Telemedicine and Telecare | volume = 23 | issue = 9 | pages = 792–796 | date = October 2017 | pmid = 27789615 | doi = 10.1177/1357633x16671407 | doi-access = free }}</ref> Economic viability relies on the funding model within the country being examined (public vs private), the consumers willingness-to-pay, and the expected remuneration by the clinicians or commercial entities providing the services (examples of research on these topics from teledermoscopy in Australia)<ref>{{cite journal | vauthors = Snoswell CL, Whitty JA, Caffery LJ, Loescher LJ, Gillespie N, Janda M | title = Direct-to-consumer mobile teledermoscopy for skin cancer screening: Preliminary results demonstrating willingness-to-pay in Australia | journal = Journal of Telemedicine and Telecare | volume = 24 | issue = 10 | pages = 683–689 | date = December 2018 | pmid = 30343653 | doi = 10.1177/1357633x18799582 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Snoswell CL, Caffery LJ, Whitty JA, Soyer HP, Gordon LG | title = Cost-effectiveness of Skin Cancer Referral and Consultation Using Teledermoscopy in Australia | journal = JAMA Dermatology | volume = 154 | issue = 6 | pages = 694–700 | date = June 2018 | pmid = 29801161 | pmc = 6145645 | doi = 10.1001/jamadermatol.2018.0855 }}</ref><ref>{{cite journal | vauthors = Snoswell CL, Whitty JA, Caffery LJ, Finnane A, Soyer HP | title = What do Australian dermatologists expect to be paid for store-and-forward teledermoscopy? A preliminary investigation | journal = Journal of Telemedicine and Telecare | volume = 25 | issue = 7 | pages = 438–444 | date = August 2019 | pmid = 29933722 | doi = 10.1177/1357633x18776766 | url = https://ueaeprints.uea.ac.uk/id/eprint/68175/1/Accepted_manuscript.pdf }}</ref>

In a UK telehealth trial done in 2011, it was reported that the cost of health could be dramatically reduced with the use of telehealth monitoring. The usual cost of [[in vitro fertilisation]] (IVF) per cycle would be around $15,000; with telehealth it was reduced to $800 per patient.<ref>{{cite journal | vauthors = Chausiaux O, Hayes J, Long C, Morris S, Williams G, Husheer S | title = Pregnancy Prognosis in Infertile Couples on the DuoFertility Programme Compared with In Vitro Fertilisation/Intracytoplasmic Sperm Injection. | journal = European Obstetrics & Gynaecology | date = 2011 | volume = 6 | issue = 2 | pages = 92–94 }}</ref> In [[Alaska Federal Health Care Access Network|Alaska the Federal Health Care Access Network]], which connects 3,000 healthcare providers to communities, engaged in 160,000 telehealth consultations from 2001 and saved the state $8.5 million in travel costs for just [[Medicaid]] patients.<ref>{{cite web |date=2013 |title=Telehealth Improves Access and Quality of Care for Alaska Natives. |url=https://innovations.ahrq.gov/perspectives/telehealth-improves-access-and-quality-care-alaska-natives |work=The Innovations Exchange Team.}}</ref>

[[Use of technology in treatment of mental disorders|Digital interventions for mental health conditions]] seem to be cost-effective compared to no intervention or non-therapeutic responses such as monitoring. However, when compared to in-person therapy or medication their added value is currently uncertain.<ref>{{cite journal | vauthors = Gega L, Jankovic D, Saramago P, Marshall D, Dawson S, Brabyn S, Nikolaidis GF, Melton H, Churchill R, Bojke L | title = Digital interventions in mental health: evidence syntheses and economic modelling | journal = Health Technology Assessment | volume = 26 | issue = 1 | pages = 1–182 | date = January 2022 | pmid = 35048909 | pmc = 8958412 | doi = 10.3310/RCTI6942 | publisher = National Institute for Health and Care Research (NIHR) }}</ref>

===Beneficial enablements===
Telemedicine can be beneficial to patients in isolated communities and remote regions, who can receive care from doctors or specialists far away without the patient having to travel to visit them.<ref>{{cite journal | vauthors = Berman M, Fenaughty A | title = Technology and managed care: patient benefits of telemedicine in a rural health care network | journal = Health Economics | volume = 14 | issue = 6 | pages = 559–573 | date = June 2005 | pmid = 15497196 | doi = 10.1002/hec.952 | publisher = [[John Wiley & Sons|Wiley]] }}</ref> Recent developments in [[mobile collaboration]] technology can allow healthcare professionals in multiple locations to share information and discuss patient issues as if they were in the same place.<ref>{{cite news | vauthors = Van't Haaff C | title = Virtually On-sight | page = 22 | publisher = Just for Canadian Doctors | date = March–April 2009 | url = http://www.justforcanadiandoctors.com/pastissues/JFCD2009/JFCD-Mar-Apr2009.pdf | archive-url = https://web.archive.org/web/20120324052954/http://www.justforcanadiandoctors.com/pastissues/JFCD2009/JFCD-Mar-Apr2009.pdf | archive-date = 2012-03-24 }}</ref> Remote patient monitoring through [[mobile technology]] can reduce the need for outpatient visits and enable remote prescription verification and drug administration oversight, potentially significantly reducing the overall cost of medical care.<ref name="MobilePatient">{{cite book | title = The Mobile Wave: How Mobile Intelligence Will Change Everything | url = https://archive.org/details/mobilewavehowmob0000sayl | url-access = registration | vauthors = Saylor M | year = 2012 | publisher = Perseus Books/Vanguard Press | page=[https://archive.org/details/mobilewavehowmob0000sayl/page/153 153]| isbn = 978-1-59315-720-3 }}</ref> It may also be preferable for patients with limited mobility, for example, patients with Parkinson's disease.<ref name="Teleneurology and mobile technologi"/> Telemedicine can also facilitate medical education by allowing workers to observe experts in their fields and share best practices more easily.<ref>{{cite journal | vauthors = Conde JG, De S, Hall RW, Johansen E, Meglan D, Peng GC | title = Telehealth innovations in health education and training | journal = Telemedicine Journal and e-Health | volume = 16 | issue = 1 | pages = 103–106 | date = January–February 2010 | pmid = 20155874 | pmc = 2937346 | doi = 10.1089/tmj.2009.0152 }}</ref>

====During war and disasters====
{{Expand section|date=July 2022}}
[[Remote surgery]] and types of videoconferencing for sharing expertise (e.g. [[ad hoc]] assistance) have been and could be used to support doctors in Ukraine during the [[2022 Russian invasion of Ukraine]].<ref>{{cite journal | vauthors = Best J | title = From Ukraine to remote robotics: how videoconferencing and next generation technology are transforming surgery | journal = BMJ | volume = 377 | article-number = o1078 | date = May 2022 | pmid = 35504650 | doi = 10.1136/bmj.o1078 | doi-access = free }}</ref>

==== Nonclinical uses ====
* [[Distance education]] including continuing medical education, grand rounds, and patient education<ref name="CFP">{{cite journal | vauthors = Masson M | title = Benefits of TED Talks | journal = Canadian Family Physician | volume = 60 | issue = 12 | page = 1080 | date = December 2014 | pmid = 25500595 | pmc = 4264800 }}</ref>
* administrative uses including meetings among telehealth networks, supervision, and presentations
* research on telehealth
* online information and [[health data]] management
* healthcare system integration
* asset identification, listing, and patient to asset matching, and movement
* overall healthcare system management
* patient movement and remote admission
* Physical distancing to prevent transmission of communicable diseases<ref>{{cite journal | vauthors = Snoswell CL, Caffery LJ, Haydon HM, Thomas EE, Smith AC | title = Telehealth uptake in general practice as a result of the coronavirus (COVID-19) pandemic | journal = Australian Health Review | volume = 44 | issue = 5 | pages = 737–740 | date = September 2020 | pmid = 32853536 | doi = 10.1071/AH20183 | doi-access = free | hdl = 11343/274283 | hdl-access = free }}</ref><ref>{{cite journal | vauthors = Smith AC, Thomas E, Snoswell CL, Haydon H, Mehrotra A, Clemensen J, Caffery LJ | title = Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19) | journal = Journal of Telemedicine and Telecare | volume = 26 | issue = 5 | pages = 309–313 | date = June 2020 | pmid = 32196391 | pmc = 7140977 | doi = 10.1177/1357633x20916567 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Zhou X, Snoswell CL, Harding LE, Bambling M, Edirippulige S, Bai X, Smith AC | title = The Role of Telehealth in Reducing the Mental Health Burden from COVID-19 | journal = Telemedicine Journal and e-Health | volume = 26 | issue = 4 | pages = 377–379 | date = April 2020 | pmid = 32202977 | doi = 10.1089/tmj.2020.0068 | doi-access = free }}</ref>

== Limitations and restrictions ==
While many branches of medicine have wanted to fully embrace telehealth for a long time, there are certain risks and barriers which bar the full amalgamation of telehealth into [[best practice]]. For a start, it is dubious as to whether a practitioner can fully leave the "hands-on" experience behind.<ref name="Umefjord-2006" /> Although it is predicted that telehealth will replace many consultations and other health interactions, it cannot yet fully replace a physical examination, this is particularly so in [[Medical diagnosis|diagnostics]], [[Physical medicine and rehabilitation|rehabilitation]] or [[mental health]].<ref name="Umefjord-2006" /> To minimise safety issues, researchers have suggested not offering remote consultations for some conditions (breathing problems, new psychosis, or acute chest pain, for example), when a parent is very concerned about a child, when a condition has not resolved as expected or has worsened, or to people who might struggle to understand or be understood (such as those with limited English or learning difficulties).<ref>{{cite journal |last1=Payne |first1=Rebecca |last2=Clarke |first2=Aileen |last3=Swann |first3=Nadia |last4=van Dael |first4=Jackie |last5=Brenman |first5=Natassia |last6=Rosen |first6=Rebecca |last7=Mackridge |first7=Adam |last8=Moore |first8=Lucy |last9=Kalin |first9=Asli |last10=Ladds |first10=Emma |last11=Hemmings |first11=Nina |last12=Rybczynska-Bunt |first12=Sarah |last13=Faulkner |first13=Stuart |last14=Hanson |first14=Isabel |last15=Spitters |first15=Sophie |last16=Wieringa |first16=Sietse |last17=Dakin |first17=Francesca H |last18=Shaw |first18=Sara E |last19=Wherton |first19=Joseph |last20=Byng |first20=Richard |last21=Husain |first21=Laiba |last22=Greenhalgh |first22=Trisha |title=Patient safety in remote primary care encounters: multimethod qualitative study combining Safety I and Safety II analysis |journal=BMJ Quality & Safety |date=September 2024 |volume=33 |issue=9 |pages=573–586 |doi=10.1136/bmjqs-2023-016674 |pmc=11347200 |pmid=38050161 }}</ref><ref>{{Cite journal |date=1 October 2024 |title=How to make remote consultations safer |url=https://evidence.nihr.ac.uk/alert/how-to-make-remote-consultations-safer/ |journal=NIHR Evidence}}</ref>

The benefits posed by telehealth challenge the normative means of healthcare delivery set in both legislation and practice. Therefore, the growing prominence of telehealth is starting to underscore the need for updated regulations, guidelines and legislation which reflect the current and future trends of healthcare practices.<ref name="Shaw-2009" /><ref name="Umefjord-2006" /> Telehealth enables timely and flexible care to patients wherever they may be; although this is a benefit, it also poses threats to [[privacy]], [[safety]] [[Medical license|, medical licensing]] and [[reimbursement]]. When a clinician and patient are in different locations, it is difficult to determine which laws apply to the context.<ref name="pmid24820794">{{cite journal | vauthors = Keck CS, Doarn CR | title = Telehealth technology applications in speech-language pathology | journal = Telemedicine Journal and E-health | volume = 20 | issue = 7 | pages = 653–9 | date = July 2014 | pmid = 24820794 | doi = 10.1089/tmj.2013.0295 }}</ref> Once healthcare crosses borders different state bodies are involved in order to regulate and maintain the level of care that is warranted to the patient or telehealth consumer. As it stands, telehealth is complex with many grey areas when put into practice especially as it crosses borders. This effectively limits the potential benefits of telehealth.<ref name="Shaw-2009" /><ref name="Umefjord-2006" />

An example of these limitations include the current American reimbursement infrastructure, where [[Medicare (United States)|Medicare]] will reimburse for telehealth services only when a patient is living in an area where specialists are in shortage, or in particular rural counties. The area is defined by whether it is a medical facility as opposed to a patient's' home. The site that the practitioner is in, however, is unrestricted. Medicare will only reimburse live video (synchronous) type services, not store-and-forward, mhealth or remote patient monitoring (if it does not involve live-video). Some insurers currently will reimburse telehealth, but not all yet. So providers and patients must go to the extra effort of finding the correct insurers before continuing. Again in America, states generally tend to require that clinicians are licensed to practice in the surgery' state, therefore they can only provide their service if licensed in an area that they do not live in themselves.<ref name=":0b" />

More specific and widely reaching laws, legislations and regulations will have to evolve with the technology. They will have to be fully agreed upon, for example, will all clinicians need full licensing in every community they provide telehealth services too, or could there be a limited use telehealth licence? Would the limited use licence cover all potential telehealth interventions, or only some? Who would be responsible if an emergency was occurring and the practitioner could not provide immediate help – would someone else have to be in the room with the patient at all consult times? Which state, city or country would the law apply in when a breach or malpractice occurred?<ref name="Umefjord-2006" /><ref name="Paul-2006">{{cite journal |last1=Paul |first1=David L. |title=Collaborative Activities in Virtual Settings: A Knowledge Management Perspective of Telemedicine |journal=Journal of Management Information Systems |date=2006 |volume=22 |issue=4 |pages=143–176 |doi=10.2753/MIS0742-1222220406 |jstor=40398816 }}</ref>

A major legal action prompt in telehealth thus far has been issues surrounding online prescribing and whether an appropriate clinician-patient relationship can be established online to make prescribing safe, making this an area that requires particular scrutiny.<ref name="Elsevier-2012" /> It may be required that the practitioner and patient involved must meet in person at least once before online prescribing can occur, or that at least a live-video conference must occur, not just impersonal questionnaires or surveys to determine need.<ref name="Cascella-2014">{{cite magazine |last1=Cascella |first1=Laura M |title=Virtual risk: An overview of telehealth from a risk management perspective |magazine=Protector |date=Spring 2014 |pages=2–13 }}</ref>

Telehealth has some potential for facilitating self-management techniques in health care, but for patients to benefit from it, the appropriate contact with, and relationship, between doctor and patient must be established first.<ref>{{cite journal | vauthors = Luz PL | title = Telemedicine and the Doctor/Patient Relationship | journal = Arquivos Brasileiros de Cardiologia | volume = 113 | issue = 1 | pages = 100–102 | date = August 2019 | pmid = 31411296 | pmc = 6684176 | doi = 10.5935/abc.20190117 }}</ref> This would start with an online consultation, providing patients with techniques and tools that help them participate in healthy behaviors, and initiating a collaborative partnership between health care professionals and patient.<ref name="ReferenceA">{{cite journal | vauthors = Dineen-Griffin S, Garcia-Cardenas V, Williams K, Benrimoj SI | title = Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice | journal = PLOS ONE | volume = 14 | issue = 8 | article-number = e0220116 | date = 2019-08-01 | pmid = 31369582 | pmc = 6675068 | doi = 10.1371/journal.pone.0220116 | bibcode = 2019PLoSO..1420116D | doi-access = free | veditors = Leroyer C }}</ref> Self-management strategies fall into a broader category called patient activation, which is defined as a "patients' willingness and ability to take independent actions to manage their health."<ref>{{cite journal | vauthors = Hibbard JH, Greene J | title = What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs | journal = Health Affairs | volume = 32 | issue = 2 | pages = 207–214 | date = February 2013 | pmid = 23381511 | doi = 10.1377/hlthaff.2012.1061 }}</ref> It can be achieved by increasing patients' knowledge and confidence in coping with and managing their own disease through a "regular assessment of progress [...] and problem-solving support."<ref name="ReferenceA"/> Teaching patients about their conditions and ways to cope with chronic illnesses will allow them to be knowledgeable about their disease and willing to manage it, improving their everyday life. Without a focus on the doctor-patient relationship and on the patient's understanding, telehealth cannot improve the quality of life of patients, despite the benefit of allowing them to do their medical check-ups from the comfort of their home.

The downsides of telemedicine include the cost of telecommunication and data management equipment and of technical training for medical personnel who will employ it. Virtual medical treatment also entails potentially decreased human interaction between medical professionals and patients, an increased risk of error when medical services are delivered in the absence of a registered professional, and an increased risk that [[protected health information]] may be compromised through electronic storage and transmission.<ref>{{cite journal | vauthors = Hjelm NM | title = Benefits and drawbacks of telemedicine | journal = Journal of Telemedicine and Telecare | volume = 11 | issue = 2 | pages = 60–70 | date = 1 March 2005 | pmid = 15829049 | doi = 10.1258/1357633053499886 }}</ref> There is also a concern that telemedicine may actually decrease time efficiency due to the difficulties of assessing and treating patients through virtual interactions; for example, it has been estimated that a [[teledermatology]] consultation can take up to thirty minutes, whereas fifteen minutes is typical for a traditional consultation.<ref>{{cite web | url = http://www.rrh.org.au/publishedarticles/article_print_1581.pdf | title = Barriers to the up-take of telemedicine in Australia – a view from providers | work = The University of Queensland, School of Medicine | vauthors = Moffatt JJ | date = February 2011}}</ref> Additionally, potentially poor quality of transmitted records, such as images or patient progress reports, and decreased access to relevant clinical information are quality assurance risks that can compromise the quality and continuity of patient care for the reporting doctor.<ref>{{cite journal | vauthors = Strehle EM, Shabde N | title = One hundred years of telemedicine: does this new technology have a place in paediatrics? | journal = Archives of Disease in Childhood | volume = 91 | issue = 12 | pages = 956–9 | date = December 2006 | pmid = 17119071 | pmc = 2082971 | doi = 10.1136/adc.2006.099622 }}</ref> Other obstacles to the implementation of telemedicine include unclear legal regulation for some telemedical practices and difficulty claiming reimbursement from insurers or government programs in some fields.<ref name="Angaran">{{cite journal | vauthors = Angaran DM | title = Telemedicine and telepharmacy: current status and future implications | journal = American Journal of Health-System Pharmacy | volume = 56 | issue = 14 | pages = 1405–26 | date = July 1999 | pmid = 10428449 | doi = 10.1093/ajhp/56.14.1405 | doi-access = free }}</ref> Some medical organizations have delivered position statement on the correct use of telemedicine in their field.<ref>{{cite journal |last1=Omboni |first1=Stefano |last2=McManus |first2=Richard J. |last3=Bosworth |first3=Hayden B. |last4=Chappell |first4=Lucy C. |last5=Green |first5=Beverly B. |last6=Kario |first6=Kazuomi |last7=Logan |first7=Alexander G. |last8=Magid |first8=David J. |last9=Mckinstry |first9=Brian |last10=Margolis |first10=Karen L. |last11=Parati |first11=Gianfranco |last12=Wakefield |first12=Bonnie J. |title=Evidence and Recommendations on the Use of Telemedicine for the Management of Arterial Hypertension: An International Expert Position Paper |journal=Hypertension |date=November 2020 |volume=76 |issue=5 |pages=1368–1383 |doi=10.1161/HYPERTENSIONAHA.120.15873 |pmid=32921195 }}</ref><ref>{{cite journal |last1=Daniel |first1=Hilary |last2=Sulmasy |first2=Lois Snyder |title=Policy Recommendations to Guide the Use of Telemedicine in Primary Care Settings: An American College of Physicians Position Paper |journal=Annals of Internal Medicine |date=17 November 2015 |volume=163 |issue=10 |pages=787–789 |doi=10.7326/M15-0498 |pmid=26344925 }}</ref><ref>{{cite journal |last1=Dramburg |first1=Stephanie |last2=Walter |first2=Uso |last3=Becker |first3=Sven |last4=Casper |first4=Ingrid |last5=Röseler |first5=Stefani |last6=Schareina |first6=Astrid |last7=Wrede |first7=Holger |last8=Klimek |first8=Ludger |title=Telemedicine in allergology: practical aspects: A position paper of the Association of German Allergists (AeDA) |journal=Allergo Journal International |date=June 2021 |volume=30 |issue=4 |pages=119–129 |doi=10.1007/s40629-021-00167-5 |pmid=33758744 |pmc=7977487 }}</ref><ref>{{cite journal |last1=Costantino |first1=Andrea |last2=Bortoluzzi |first2=Francesco |last3=Giuffrè |first3=Mauro |last4=Vassallo |first4=Roberto |last5=Montalbano |first5=Luigi Maria |last6=Monica |first6=Fabio |last7=Canova |first7=Daniele |last8=Checchin |first8=Davide |last9=Fedeli |first9=Paolo |last10=Marmo |first10=Riccardo |last11=Elli |first11=Luca |title=Correct use of telemedicine in gastroenterology, hepatology, and endoscopy during and after the COVID-19 pandemic: Recommendations from the Italian association of hospital gastroenterologists and endoscopists (AIGO) |journal=Digestive and Liver Disease |date=October 2021 |volume=53 |issue=10 |pages=1221–1227 |doi=10.1016/j.dld.2021.06.032 |pmid=34312103 }}</ref>

Another disadvantage of telemedicine is the inability to start treatment immediately. For example, a patient with a bacterial infection might be given an [[antibiotic]] [[hypodermic injection]] in the clinic, and observed for any reaction, before that antibiotic is prescribed in pill form.

Equitability is also a concern. Many families and individuals in the United States, and other countries, do not have internet access in their homes or the proper electronic devices to access services such as a laptop or smartphone.{{cn|date=April 2024}}

== Ethical issues ==
{{See also|Informed consent|Medical ethics}}

''[[Informed consent]]'' is another issue. When telehealth includes the possibility for technical problems such as transmission errors, security breaches, or storage issues, it can impact the system's ability to communicate. It may be wise to obtain informed consent in person first, as well as having backup options for when technical issues occur. In person, a patient can see who is involved in their care (namely themselves and their clinician in a consult), but online there will be other involved such as the technology providers, therefore consent may need to involve disclosure of anyone involved in the transmission of the information and the security that will keep their information private, and any legal malpractice cases may need to involve all of those involved as opposed to what would usually just be the practitioner.<ref name="Elsevier-2012" /><ref name="Paul-2006" /><ref name="Cascella-2014" />

== State of the market ==
The rate of adoption of telehealth services in any jurisdiction is frequently influenced by factors such as the adequacy and cost of existing conventional [[health care|health services]] in meeting [[patient|patient needs]]; the policies of governments and/or insurers with respect to coverage and payment for telehealth services; and medical licensing requirements that may inhibit or deter the provision of telehealth second opinions or primary consultations by physicians.

Projections for the growth of the telehealth market are optimistic, and much of this optimism is predicated upon the increasing demand for remote medical care. According to a recent survey, nearly three-quarters of U.S. consumers say they would use telehealth.<ref name="healthdata">{{cite web|url=http://www.healthdatamanagement.com/news/telemedicine-38701-1.html|title=Survey: Consumers Keen on Telemedicine|access-date=2010-04-26|archive-date=2010-04-29|archive-url=https://web.archive.org/web/20100429075350/http://www.healthdatamanagement.com/news/telemedicine-38701-1.html}}</ref> At present, several major companies along with a bevvy of startups are working to develop a leading presence in the field.

In the UK, the Government's Care Services minister, Paul Burstow, has stated that telehealth and [[telecare]] would be extended over the next five years (2012–2017) to reach three million people.

===United States===
In the United States, telemedicine companies are collaborating with health insurers and other telemedicine providers to expand marketshare and patient access to telemedicine consultations.

{{as of|2019}}, 95% of employers believe their organizations will continue to provide health care benefits over the next five years.<ref>''[https://www.willistowerswatson.com/en-US/Insights/2019/11/2019-best-practices-in-health-care-employer-survey-highlights 2019 Best Practices in Health Care Employer Survey Highlights]'', Willis Towers Watson, November 5, 2019</ref>

The COVID-19 pandemic drove increased usage of telehealth services in the U.S. The U.S. Centers for Disease Control and Prevention reported a 154% increase in telehealth visits during the last week of March 2020, compared to the same dates in 2019.<ref>''[https://www.cdc.gov/mmwr/volumes/69/wr/mm6943a3.htm?s_cid=mm6943a3_e&ACSTrackingID=USCDC_921-DM41453&ACSTrackingLabel=This%20Week%20in%20MMWR%20-%20Vol.%2069%2c%20October%2030%2c%202020&deliveryName=USCDC_921-DM41453 Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic — United States, January–March 2020]'', Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report (MMWR), October 30, 2020</ref>

=== Switzerland ===
From 1999 to 2018, the [[University Hospital of Zürich|University Hospital of Zurich]] (USZ) offered clinical telemedicine and online medical advice on the Internet. A team of doctors answered around 2500 anonymous inquiries annually, usually within 24 to 48 hours. The team consisted of up to six physicians who are specialists in clinical telemedicine at the USZ and have many years of experience, particularly in internal and general medicine. In the entire period, 59360 inquiries were sent and answered.<ref>{{cite journal | vauthors = Kessler SH, Schmidt-Weitmann S | title = Diseases and Emotions: An Automated Content Analysis of Health Narratives in Inquiries to an Online Health Consultation Service | journal = Health Communication | volume = 36 | issue = 2 | pages = 226–235 | date = February 2021 | pmid = 36112901 | doi = 10.1080/10410236.2019.1673950 | url = https://www.zora.uzh.ch/id/eprint/175841/1/Schmidt_Manuskript_Diseases_and_Emotions.pdf }}</ref> The majority of the users were female and on average 38 years old. However, in the course of time, considerably more men and older people began to use the service. The diversity of medical queries covered all categories of the [[International Statistical Classification of Diseases and Related Health Problems]] (ICD) and correlated with the statistical frequency of diseases in hospitals in Switzerland. Most of the inquiries concerned unclassified symptoms and signs, services related to reproduction, respiratory diseases, skin diseases, health services, diseases of the eye and nervous systems, injuries and disorders of the female genital tract. As with the Swedish online medical advice service,<ref>{{cite journal | vauthors = Umefjord G, Sandström H, Malker H, Petersson G | title = Medical text-based consultations on the Internet: a 4-year study | journal = International Journal of Medical Informatics | volume = 77 | issue = 2 | pages = 114–121 | date = February 2008 | pmid = 17317292 | doi = 10.1016/j.ijmedinf.2007.01.009 }}</ref> one-sixth of the requests related to often shameful and [[Social stigma|stigmatised]] diseases of the genitals, gastrointestinal tract, sexually transmitted infections, obesity and mental disorders. By providing an anonymous space where users can talk about (shameful) diseases, online telemedical services empower patients and their health literacy is enhanced by providing individualized health information. The Clinical Telemedicine and Online Counselling service of the University Hospital of Zurich is currently being revised and will be offered in a new form in the future.<ref>{{Cite web|url=http://www.usz.ch/Seiten/Telemedizin.aspx|title=Willkommen am UniversitätsSpital Zürich|website=www.usz.ch|language=de-CH|access-date=2020-01-23|archive-date=2020-01-17|archive-url=https://web.archive.org/web/20200117122940/http://www.usz.ch/Seiten/Telemedizin.aspx}}</ref>

== Developing countries ==
For developing countries, telemedicine and [[eHealth]] can be the only means of healthcare provision in remote areas. For example, the difficult financial situation in many African states and lack of trained health professionals has meant that the majority of the people in sub-Saharan Africa are badly disadvantaged in medical care, and in remote areas with low population density, direct healthcare provision is often very poor<ref>[https://web.archive.org/web/20160205083116/http://euroafrica-ict.org.sigma-orionis.com/downloads/Coop_Forum/SessionC/Adesina_Iluyemi.pdf ''Refocusing Europe-Africa Strategy: Strategic Importance of eHealth''] NEPAD. Accessed 28 January 2016.</ref> However, provision of telemedicine and eHealth from urban centers or from other countries is hampered by the lack of communications infrastructure, with no landline phone or broadband internet connection, little or no mobile connectivity, and often not even a reliable electricity supply.<ref>Gerhard Bethscheider [http://www.worldteleport.org/news/249029/Satellite-Is-Vital-For-A-Unified-Global-e-Health-System...-An-SES-Techcom-Services-Perspective-.htm ''Satellite is vital for a unified, global, E-Health system''] September 2015 World Teleport Association. Accessed 28 January 2016.</ref>

=== Telemedicine in developing countries ===

==== Telemedicine in India ====
India has broad rural-urban population and rural India is bereaved from medical facilities, giving telemedicine a space for growth in India. Deprived education and medical professionals in rural areas is the reason behind government's ideology to use technology to bridge this gap. Remote areas not only present a number of challenges for the service providers but also for the families who are accessing these services. Since 2018, telemedicine has expanded in India. It has undertaken a new way for doctor consultations. On 25 March 2020, in the wake of COVID-19 pandemic, the [[Ministry of Health and Family Welfare]] issued India's Telemedicine Practice Guidelines.<ref>{{Cite web |title=Telemedicine Practice Guidelines of India |url=https://www.reclica.com/telemedicine-guidelines.html}}</ref> The Board of Governors entasked by the Health Ministry published an amendment to the [[Indian Medical Council]] (Professional Conduct, Etiquette and Ethics) Regulations, 2002 that gave much-needed statutory support for the practice of telemedicine in India. This sector is at an ever-growing stage with high scope of development.<ref name="economictimes">{{cite news |title=The future of Telemedicine in India |url=https://health.economictimes.indiatimes.com/news/health-it/outlook-2019-the-future-of-telemedicine-in-india/67366188 |access-date=19 May 2020}}</ref> In April 2020, the union health ministry launched the eSanjeevani telemedicine service that operates at two levels: the doctor-to-doctor telemedicine platform, and the doctor-to-patient platform. This service crossed five million tele-consultations within a year of its launch indicating conducive environment for acceptability and growth of telemedicine in India.<ref>{{Cite web |date=2021-05-14 |title= Govt's telemedicine service crosses 5 million consultations |url=https://www.hindustantimes.com/india-news/govts-telemedicine-service-crosses-5-million-consultations-101620965457038.html |access-date=2021-10-10|website=Hindustan Times|language=en}}</ref>

==== Telemedicine in Sub-Saharan Africa ====
[[File:Travel Time to the Nearest Health-Care Facility for adults aged 60 years or older, by sub-Saharan African region.jpg|thumb|Travel time to the nearest health-care facility by Sub-Saharan African region, for adults aged 60 years or older]]
Sub-Saharan Africa is marked by the massive introduction of new technologies and internet access.<ref>{{cite book |doi=10.1109/istafrica.2015.7190589 |chapter=On bringing governance into technology: Case of Internet governance and implications for Africa |title=2015 IST-Africa Conference |date=2015 |last1=Kanjo |first1=Chipo |last2=Jere |first2=Towela |pages=1–12 |isbn=978-1-9058-2451-9 }}</ref> Urban areas are facing a rapid change and development, and access to internet and health is rapidly improving. Population in remote areas however, still lack access to healthcare and modern technologies. Some people in rural regions must travel more between 2 and 6 hours to reach the closest healthcare facilities of their country.<ref>{{Cite medRxiv |vauthors=Geldsetzer P, Reinmuth M, Ouma PO, Lautenbach S, Okiro EA, Bärnighausen T, Zipf A |title=Mapping physical access to healthcare for older adults in sub-Saharan Africa: A cross-sectional analysis with implications for the COVID-19 response |date=August 2020 |medrxiv=10.1101/2020.07.17.20152389}}</ref> leaving room for telehealth to grow and reach isolated people in the near future.

=== Internet via satellite in rural areas ===
The Satellite African eHEalth vaLidation (SAHEL) demonstration project has shown how [[Satellite Internet access|satellite broadband]] technology can be used to establish telemedicine in such areas. SAHEL was started in 2010 in Kenya and Senegal, providing self-contained, solar-powered internet terminals to rural villages for use by community nurses for collaboration with distant health centers for training, diagnosis and advice on local health issues.<ref>[https://web.archive.org/web/20160203143432/http://www.ses.com/14444955/SES_Broadband_SAHEL_case_study_EN.pdf ''Helping to build sustainable eHealth services in Africa''] SES Broadband. Company brochure. Accessed 28 January 2016.</ref> Those methods can have major impact on both health professionals to get and provide training from remote areas, and on the local population who can receive care without traveling long distances. Some non-profits provide internet to rural places around the world using a mobile VSAT terminal. This VSAT terminal equips remote regions allowing them to alert the world when there is a medical emergency, resulting in a rapid deployment or response from developed countries.<ref>{{cite journal |last1=Wilk-Jakubowski |first1=Jacek |title=A review on information systems engineering using vsat networks and their development directions |journal=Yugoslav Journal of Operations Research |date=2021 |volume=31 |issue=3 |pages=409–428 |doi=10.2298/yjor200215015w |doi-access=free }}</ref> Technologies such as the ones used by MAF allows health professionals in remote clinics to have internet access, making consultations much easier, both for patients and doctors.

In 2014, the government of Luxembourg, along with satellite operators and NGOs established [[Satmed|SATMED]], a multilayer eHealth platform to improve public health in remote areas of emerging and developing countries, using the [[Emergency.lu]] disaster relief satellite platform and the [[Astra 2G]] TV satellite.<ref>Caleb Henry [http://www.satellitetoday.com/telecom/2014/09/25/ses-joins-clinton-global-initiative-announces-satmed-project/ ''SES Joins Clinton Global Initiative, Announces SATMED Project''] September 25, 2014 Satellite Today. Accessed 28 January 2016.</ref> SATMED was first deployed in response to a report in 2014 by German Doctors of poor communications in Sierra Leone hampering the fight against Ebola, and SATMED equipment arrived in the Serabu clinic in [[Sierra Leone]] in December 2014.<ref>[http://www.cooperation.lu/2014/en/613/SATMED Satmed] {{Webarchive|url=https://web.archive.org/web/20180720153252/http://www.cooperation.lu/2014/en/613/SATMED |date=2018-07-20 }} Luxembourg's Development Cooperation. Accessed February 26, 2016</ref><ref>[https://satelliteprome.com/emagazine/satellite_pro_february_2017.pdf ''E-Inclusion: Satellites Are The Answer''] Satellite Pro. Issue 59 February 2017. Accessed 27 June 2022</ref> In June 2015 SATMED was deployed at Maternité Hospital in Ahozonnoude, Benin to provide remote consultation and monitoring, and is the only effective communication link between Ahozonnoude, the capital and a third hospital in Allada, since land routes are often inaccessible due to flooding during the rainy season.<ref>[https://www.reuters.com/article/idUSFWN0YP03O20150604 SES SATMED ehealth platform deployed in hospital in Benin] Reuters June 4, 2015. Accessed February 26, 20166</ref><ref>[http://www.satmagazine.com/story.php?number=993564177 Executive Spotlight: Gerhard Bethscheider] SatMagazine November 2015. Accessed February 26, 20166</ref>

== History ==
The development and history of telehealth or telemedicine (terms used interchangeably in literature) is deeply rooted in the history and development in not only technology but also society itself. Humans have long sought to relay important messages through [[torch]]es, [[Semaphore line|optical telegraphy]], [[electroscope]]s, and [[Wireless|wireless transmission]]. Early forms of telemedicine achieved with telephone and radio have been supplemented with [[videotelephony]], advanced [[Medical diagnosis|diagnostic methods]] supported by [[Client–server model|distributed client/server applications]], and additionally with telemedical devices to support in-home care.<ref name="Sachpazidis"/>

In the 21st century, with the advent of the [[internet]], [[Mobile device|portable devices]] and other such digital devices are taking a transformative role in healthcare and its delivery.<ref name="Bashshur-2009">{{cite book |last1=Bashshur |first1=Rashid |last2=Shannon |first2=Gary William |title=History of Telemedicine: Evolution, Context, and Transformation |date=2009 |publisher=Mary Ann Liebert |isbn=978-1-934854-11-2 }}{{pn|date=July 2025}}</ref>

=== Earliest instances ===
Although, [[traditional medicine]] relies on in-person care, the need and want for remote care has existed from the Roman and pre-Hippocratic periods in antiquity. The elderly and infirm who could not visit temples for medical care sent representatives to convey information on symptoms and bring home a diagnosis as well as treatment.<ref name="Bashshur-2009" /> In Africa, villagers would use [[smoke signal]]s to warn neighboring villages of disease outbreak.<ref name="Nakajima-2006">{{cite book |doi=10.1109/HEALTH.2006.246471 |chapter=The Asia Pacific telecommunity's telemedicine activities |title=HEALTHCOM 2006 8th International Conference on e-Health Networking, Applications and Services |date=2006 |last1=Nakajima |first1=I. |last2=Sastrokusumo |first2=U. |last3=Mishra |first3=S.K. |last4=Komiya |first4=R. |last5=Malik |first5=A.Z. |last6=Tanuma |first6=T. |pages=280–282 |isbn=0-7803-9704-5 }}</ref> The beginnings of telehealth have existed through primitive forms of communication and technology.<ref name="Bashshur-2009" /> The exact date of origin for Telehealth is unknown, but it was known to have been used during the [[Bubonic plague|Bubonic Plague]]. That version of telehealth was far different from how we know it today. During that time, they were communicating by [[heliograph]] and bonfire. Those were used to notify other groups of people about famine and war.<ref name="Cuffia 84–85">{{Cite journal| vauthors = Cuffia A |date=2019-01-02|title=The Medical Library Association Guide to Developing Consumer Health Collections |journal= Journal of Hospital Librarianship |volume=19 |issue=1 |pages=84–85 |doi=10.1080/15323269.2019.1568127 }}</ref> Those are not using any form of technology yet but are starting to spread the idea of connectivity among groups of people who geographically could not be together.

=== 1800s to early 1900s ===
As technology developed and wired communication became increasingly commonplace, the ideas surrounding telehealth began emerging. The earliest telehealth encounter can be traced to [[Alexander Graham Bell]] in 1876, when he used his early telephone as a means of getting help from his assistant Mr. Watson after he spilt acid on his trousers. Another instance of early telehealth, specifically telemedicine was reported in ''[[The Lancet]]'' in 1879. An anonymous writer described a case where a doctor successfully diagnosed a child over the telephone in the middle of the night.<ref name="Bashshur-2009" /> This Lancet issue, also further discussed the potential of Remote Patient Care in order to avoid unnecessary house visits, which were part of routine health care during the 1800s.<ref name="Bashshur-2009" /><ref name="Zundel-1996">{{cite journal | vauthors = Zundel KM | title = Telemedicine: history, applications, and impact on librarianship | journal = Bulletin of the Medical Library Association | volume = 84 | issue = 1 | pages = 71–9 | date = January 1996 | pmid = 8938332 | pmc = 226126 }}</ref> Other instances of telehealth during this period came from the [[American Civil War]], during which telegraphs were used to deliver casualty/mortality lists, medical care to soldiers,<ref name="Zundel-1996" /> and ordering further medical supplies.<ref name= Bonica2024>{{cite journal |last1=Bonica |first1=Gina M. |last2=Johns |first2=Richard W. |last3=Jadvar |first3=Hossein |title=Telehealth and Telemedicine: Regulatory and Medicolegal Landscape |journal=Clinical Nuclear Medicine |date=July 2024 |volume=49 |issue=7 |pages=644–647 |doi=10.1097/RLU.0000000000005254 |pmid=38769654 }}</ref>

As the 1900s started, physicians quickly found a use for the telephone making it a prime communication channel to contact patients and other physicians.<ref name="Cuffia 84–85"/> Over the next fifty-plus years, the telephone was a staple for medical communication. As the 1930s came around, radio communication played a key role, especially during World War I. It was specifically used to communicate with remote areas such as Alaska and Australia.<ref name="Cuffia 84–85"/> They used the radio to communicate medical information. During the Vietnam War, radio communication had become more advanced and was now used to send medical teams in helicopters to help. This then brought together the Aerial Medical Service (AMS) who used telegraphs, radios, and planes to help care for people who lived in remote areas.

From the late 1800s to the early 1900s the early foundations of [[Wireless|wireless communication]] were laid down.<ref name="Bashshur-2009" /> [[Radio]]s provided an easier and near instantaneous form of communication. The use of radio to deliver healthcare became accepted for remote areas.<ref name="Bashshur-2009" /><ref name="Maheu-2002">{{cite book |last1=Maheu |first1=Marlene |last2=Whitten |first2=Pamela |last3=Allen |first3=Ace |title=E-Health, Telehealth, and Telemedicine: A Guide to Startup and Success |date=2002 |publisher=John Wiley & Sons |isbn=978-0-7879-5903-6 }}{{pn|date=July 2025}}</ref> The [[Royal Flying Doctor Service of Australia]] is an example of the early adoption of radios in telehealth.<ref name="Nakajima-2006" />

In 1925 the inventor [[Hugo Gernsback]] wrote an article for the magazine ''[[Science and Invention]]'' which included a prediction of a future where patients could be treated remotely by doctors through a device he called a "teledactyl". His descriptions of the device are similar to what would later become possible with new technology.<ref>{{cite web | vauthors = Novak M | date = 14 March 2012 | url = https://www.smithsonianmag.com/history/telemedicine-predicted-in-1925-124140942/ | title = Telemedicine Predicted in 1925 | work = The Smithsonian Institution }}</ref>

=== Mid-1900s to 1980s ===
When the American [[NASA|National Aeronautics and Space Administration (NASA)]] began plans to send astronauts into space, the need for telemedicine became clear. In order to monitor their astronauts in space, telemedicine capabilities were built into the [[spacecraft]] as well as the first [[Space suit|spacesuits]].<ref name="Bashshur-2009" /><ref name="Maheu-2002" /> Additionally, during this period, telehealth and telemedicine were promoted in different countries especially the United States and Canada.<ref name="Bashshur-2009" /> [[Carrier Sekani Family Services]] helped pioneer telehealth in British Columbia and Canada, according to its CEO Warner Adam.<ref>
{{Citation
| last        = Elizabeth
| first       = McSheffrey
| year        = 2022
| title       = 'Better outcomes': B.C. organization gets American award for championing Indigenous children
| publisher   = Global News
| publication-place = Canada
| page        =
| url         = https://globalnews.ca/news/8670897/carrier-sekani-bc-award-indigenous-child-welfare/
| access-date = 2023-08-01
}}
</ref> After the telegraph and telephone started to successfully help physicians treat patients from remote areas, telehealth became more recognized. Technological advancements occurred when NASA sent men to space. Engineers for NASA created biomedical telemetry and [[telecommunications]] systems.<ref name="Cuffia 84–85"/> NASA technology monitored vitals such as blood pressure, heart rate, respiration rate, and temperature. After the technology was created, it then became the base of telehealth medicine for the public.

[[Massachusetts General Hospital]] and Boston's [[Logan International Airport]] had a role in the early use of telemedicine, which more or less coincided with NASA's foray into telemedicine through the use of physiologic monitors for astronauts.<ref>[http://tie.telemed.org/articles/article.asp?path=articles&article=tmhistory_nb_tie95.xml "A Brief History of Telemedicine" ] {{webarchive|url=https://web.archive.org/web/20071124075453/http://tie.telemed.org/articles/article.asp?path=articles&article=tmhistory_nb_tie95.xml|date=2007-11-24}}, Telemedicine Information Exchange website, (Accessed December 10, 2008)</ref> On October 26, 1960, a plane struck a flock of birds upon takeoff, killing many passengers and leaving a number wounded. Due to the extreme complexity of trying to get all the medical personnel out from the hospital, the practical solution became telehealth.<ref name = "Weinstein_2011">{{cite book |doi=10.1007/978-3-030-56917-4_1 |chapter=First Trainees: The Golden Anniversary of the Early History of Telemedicine Education at the Massachusetts General Hospital and Harvard (1968–1970) |title=Telemedicine, Telehealth and Telepresence |date=2021 |last1=Weinstein |first1=Ronald S. |last2=Holcomb |first2=Michael J. |last3=Krupinski |first3=Elizabeth A. |last4=Latifi |first4=Rifat |pages=3–18 |isbn=978-3-030-56916-7 }}</ref> This was expanded upon in 1967, when Kenneth Bird at Massachusetts General founded one of the first telemedicine clinics. The clinic addressed the fundamental problem of delivering occupational and emergency health services to employees and travellers at the airport, located three congested miles from the hospital. Clinicians at the hospital would provide consultation services to patients who were at the airport. Consultations were achieved through microwave audio as well as video links.<ref name="Bashshur-2009" /><ref name="Allan-2006" /> The airport began seeing over a hundred patients a day at its nurse-run clinic that cared for victims of plane crashes and other accidents, taking vital signs, electrocardiograms, and video images that were sent to Massachusetts General.<ref>{{cite journal |last1=Buhler |first1=Leo H. |title=Recollections of Pioneers in Xenotransplantation Research Edited by David K. C.Cooper, Nova Medicine and Health, Nova Science Publishers, New York, NY, 2018. |journal=Xenotransplantation |date=January 2019 |volume=26 |issue=1 |article-number=e12495 |doi=10.1111/xen.12495 }}</ref> Over 1,000 patients are documented as having received remote treatment from doctors at MGH using the clinic's two-way audiovisual microwave circuit.<ref>[http://www.medscape.com/viewarticle/457684 "Highlights from the Eighth Annual Meeting of the American Telemedicine Association"] (Accessed December 10, 2008), Medscape website</ref> One notable story featured a woman who got off a flight in Boston and was experiencing chest pain. They performed a workup at the airport, took her to the telehealth suite where Raymond Murphy appeared on the television, and had a conversation with her. While this was happening, another doctor took notes and the nurses took vitals and any test that Murphy ordered.<ref name = "Weinstein_2011" /> At this point, telehealth was becoming more mainstream and was starting to become more technologically advanced, which created a viable option for patients.

In 1964, the Nebraska Psychiatric Institute began using television links to form two-way communication with the Norfolk State Hospital which was 112 miles away for the education and consultation purposes between clinicians in the two locations.<ref name="Allan-2006">{{Cite web|url=http://electronicdesign.com/components/brief-history-telemedicine|title=A Brief History Of Telemedicine| vauthors = Allan R |date=28 June 2006|publisher=Electronic Design}}</ref>

In 1972 the [[United States Department of Health, Education, and Welfare|Department of Health, Education and Welfare]] in the United States approved funding for seven telemedicine projects across different states. This funding was renewed and two further projects were funded the following year.<ref name="Bashshur-2009" /><ref name="Allan-2006" />

In March 1972, the San Bernardino County Medical Society officially implemented its Tel-Med program, a system of prerecorded health-related messages, with a log of 50 tapes.<ref name="Harer-1979">{{cite journal | vauthors = Harer WB | title = Tel-Med--a success story | journal = The Western Journal of Medicine | volume = 131 | issue = 2 | pages = 162–164 | date = August 1979 | pmid = 516712 | pmc = 1271730 }}</ref><ref name="Rovner-1979">{{Cite news | vauthors = Rovner S |date=7 September 1979 |title=Health Talk: With Tel-Med, Medical Information Is Only a Phone Call Away |newspaper=The Washington Post |url=https://www.washingtonpost.com/archive/lifestyle/1979/09/07/health-talk-with-tel-med-medical-information-is-only-a-phone-call-away/5cf7ba20-a2da-454a-a9c8-868ac832e52a/ |access-date=12 May 2022}}</ref> The nonprofit initiative began in 1971 as a local medical project to ease the doctor shortage in the expanding [[San Bernardino Valley]] and improve the public's access to sound medical information.<ref name="Rovner-1979" /><ref name="Harer-1979" /> It covered subjects ranging from [[Cannabis (drug)|cannabis]] to [[vaginitis]].<ref name="Harer-1979" /> In January 1973, in response to the developing "[[London flu]]" epidemic hitting California and the country, a tape providing information on the disease was on air within a week after news broke of the flu spreading in the state.<ref>{{Cite news |date=10 January 1973 |title=Tel-Med Proves Its Versatility |page=22 |work=The San Bernardino Sun |url=https://cdnc.ucr.edu/?a=d&d=SBS19730110.1.22&srpos=209&e=------197-en--20--201--txt-txIN--------1 |access-date=12 May 2022}}</ref> That spring, programs were implemented in [[San Diego]] and [[Indianapolis|Indianapolis, Indiana]], signaling a national acceptance of the concept.<ref name="Rovner-1979" /> By 1979, its system offered messages on over 300 different subjects, 200 of which were available in Spanish as well as English, and serviced over 65 million people in 180 cities around the country.<ref name="Harer-1979" />

=== 1980s to 1990s – maturation and renaissance ===
Telehealth projects underway before and during the 1980s would take off but fail to enter mainstream healthcare.<ref name="Nakajima-2006" /><ref name="Maheu-2002" /> As a result, this period of telehealth history is called the "maturation" stage and made way for sustainable growth.<ref name="Bashshur-2009" /> Although state funding in North America was beginning to run low, different hospitals began to launch their own telehealth initiatives.<ref name="Bashshur-2009" /> NASA provided an ATS-3 satellite to enable medical care communications of [[American Red Cross]] and [[Pan American Health Organization]] response teams, following the [[1985 Mexico City earthquake]]. The agency then launched its SateLife/HealthNet programme to increase health service connectivity in developing countries. In 1997, NASA sponsored [[Yale]]'s Medical Informatics and Technology Applications Consortium project.<ref name="Maheu-2002" /><ref>{{cite news | url = https://www.forbes.com/sites/jonmarkman/2018/08/26/nasa-incubated-healthcare-provider-is-out-of-this-world/#7b5ff82b62ac | title = NASA-Incubated Healthcare Provider Is Out Of This World | vauthors = Markman J | date = August 26, 2018 | access-date=2019-10-06}}</ref>

Florida first experimented with "primitive" telehealth in its [[Florida Department of Corrections|prisons]] during the latter 1980s.<ref>{{cite journal |last1=Berger |first1=Eric |title=Telemedicine: Has Its Time Come? |journal=Annals of Emergency Medicine |date=November 2010 |volume=56 |issue=5 |pages=A15–A17 |doi=10.1016/j.annemergmed.2010.09.008 |pmid=21064235 }}</ref> Working with Doctors Oscar W. Boultinghouse and Michael J. Davis, from the early 1990s to 2007; Glenn G. Hammack led the [[University of Texas Medical Branch]] (UTMB) development of a pioneering telehealth program in [[Texas Department of Criminal Justice|Texas state prisons]]. The three UTMB alumni would, in 2007, co-found telehealth provider NuPhysician.<ref>{{cite news | url = https://www.nytimes.com/2010/05/30/business/30telemed.html | title = The Doctor Will See You Now. Please Log On. | vauthors = Freudenheim M | newspaper = The New York Times | date = May 29, 2010 | access-date = 2019-10-03}}</ref>

The first interactive telemedicine system, operating over standard telephone lines, designed to [[Remote diagnostics|remotely diagnose]] and treat patients requiring cardiac resuscitation ([[defibrillation]]) was developed and launched by an American company, MedPhone Corporation, in 1989. A year later under the leadership of its President/CEO S Eric Wachtel, MedPhone introduced a mobile cellular version, the MDPhone. Twelve hospitals in the U.S. served as receiving and treatment centers.<ref>{{cite book | vauthors = Blyth WJ | title = Telecommunications, Concepts, Development, and Management | edition = Second | publisher = Glencoe/McCgraw-Hill | year = 1990 | pages = 280–282 |isbn=978-0-02-680841-5}}</ref>

=== At-home virtual care ===
As the expansion of telehealth continued in 1990 Maritime Health Services (MHS) was a big part of the initiation for occupational health services. They sent a medical officer aboard the Pacific trawler that allowed for round-the-clock communication with a physician. The system that allows for this is called the Medical Consultation Network (MedNet). MedNet is a video chatting system that has live audio and visual so the physician on the other end of the call can see and hear what is happening. MetNet can be used from anywhere, not just aboard ships.<ref name="Cuffia 84–85"/> Being able to provide onsite visual information allows remote patients expert emergency help and medical attention that saves money as well as lives. This has created a demand for at-home monitoring. At-home care has also become a large part of telehealth. Doctors or nurses will now give pre-op and post-op phone calls to check-in. There are also companies such as [[Lifeline Systems, Inc.|Lifeline]], which give the elderly a button to press in case of an emergency. That button will automatically call for emergency help. If someone has surgery and then is sent home, telehealth allows physicians to see how the patient is progressing without them having to stay in the hospital. TeleDiagnostic Systems of San Francisco is a company that has created a device that monitors sleep patterns, so people with sleep disorders do not have to stay the night at the hospital.<ref name="Cuffia 84–85"/> Another at-home device that was created was the Wanderer, which was attached to Alzheimer's patients or people who had dementia. It was attached to them so when they wandered off it notified the staff to allow them to go after them. All these devices allowed healthcare beyond hospitals to improve, which means that more people are being helped efficiently.

=== 2000s to present ===
The advent of high-speed [[Internet]], and the increasing adoption of [[Information and communications technology|ICT]] in traditional methods of care, spurred advances in telehealth delivery.<ref name="The Center for Connected Health Policy">{{Cite web|url=http://cchpca.org/what-is-telehealth|archive-url=https://web.archive.org/web/20120115222043/http://cchpca.org/what-is-telehealth|url-status=live|archive-date=January 15, 2012|title=What is Telehealth?|publisher=The Center for Connected Health Policy}}</ref> Increased access to portable devices, like laptops and mobile phones, made telehealth more plausible; the industry then expanded into health promotion, prevention and education.<ref name="Office for the Advancement of Telehealth-2022" /><ref name="CFP"/><ref name="Maheu-2002" />

In 2002, G. Byron Brooks, a former NASA surgeon and engineer who had also helped manage the [[University of Texas Medical Branch|UTMB]] Telemedicine program, co-founded [[Teladoc]] in [[Dallas, Texas]], which was then launched in 2005 as the first national telehealth provider.<ref>{{Cite news|url=https://www.dmagazine.com/publications/d-ceo/2016/november/how-the-north-texas-telemedicine-revolution-began/ |title = How the North Texas Telemedicine Revolution Began | vauthors = Goodman M | newspaper = D Magazine | date = November 2016 | access-date = 2019-10-03}}</ref>

In the 2010s, integration of smart home telehealth technologies, such as health and wellness devices, software, and integrated [[Internet of things|IoT]], has accelerated the industry. Healthcare organizations are increasingly adopting the use of self-tracking and cloud-based technologies, and innovative data analytic approaches to accelerate telehealth delivery.{{citation needed|date=October 2019}}<ref>{{cite journal | vauthors = Dinesen B, Nonnecke B, Lindeman D, Toft E, Kidholm K, Jethwani K, Young HM, Spindler H, Oestergaard CU, Southard JA, Gutierrez M, Anderson N, Albert NM, Han JJ, Nesbitt T | title = Personalized Telehealth in the Future: A Global Research Agenda | journal = Journal of Medical Internet Research | volume = 18 | issue = 3 | pages = e53 | date = March 2016 | pmid = 26932229 | pmc = 4795318 | doi = 10.2196/jmir.5257 | doi-access = free }}</ref>

In 2015, [[Mercy (healthcare organization)|Mercy Health system]] opened [[Mercy Virtual]], in Chesterfield, Missouri, the world's first medical facility dedicated solely to telemedicine.<ref>{{cite news |last1=Allen |first1=Arthur |title=A hospital without patients |url=https://www.politico.com/agenda/story/2017/11/08/virtual-hospital-mercy-st-louis-000573/ |work=The Agenda |publisher=Politico |date=8 November 2017 }}</ref>

==== COVID-19 ====
{{See also|#Health care quality and barriers to adoption}}
Telehealth expanded significantly during the [[COVID-19 pandemic]], becoming a vital means of medical communication. It allows doctors to return to humanizing the patient.<ref name="Schiffman">{{cite news |last1=Schiffman |first1=Richard |date=25 February 2021 |title=Learning to Listen to Patients' Stories |newspaper=The New York Times |id={{ProQuest|2492893443}} |url=https://www.nytimes.com/2021/02/25/well/live/narrative-medicine.html }}</ref> It forces them to listen to what people have to say and from there make a diagnosis. Studies have demonstrated high trust in telehealth expressed by patients during the [[COVID-19 pandemic]].<ref>{{cite journal |vauthors=Costantino A, Noviello D, Mazza S, Berté R, Caprioli F, Vecchi M |title=Trust in telemedicine from IBD outpatients during the COVID-19 pandemic |journal=Dig Liver Dis |volume=53 |issue=3 |pages=291–4 |date=March 2021 |pmid=33187917 |pmc=7644233 |doi=10.1016/j.dld.2020.10.035 }}</ref> Among patients with [[Inflammatory bowel disease]] 4 out of 5 considered telemedicine as valuable tool for their management, and 85%) wanted to have a telemedicine service at their center. However, only 1 out of 4 believed that it may guarantee the same level of care as the in-person visit.<ref>{{cite journal |last1=Bossa |first1=F. |last2=Valvano |first2=M.R. |last3=Vetrone |first3=L.M. |last4=Guerra |first4=M. |last5=Lopetuso |first5=L.R. |last6=Carparelli |first6=S. |last7=Mignini |first7=I. |last8=Cocomazzi |first8=F. |last9=Napolitano |first9=D. |last10=Costantino |first10=A. |last11=Caprioli |first11=F. |last12=Gasbarrini |first12=A. |last13=Perri |first13=F. |last14=Papa |first14=A. |title=Evaluation of factors associated with trust in telemedicine in patients with inflammatory bowel disease during COVID-19 pandemic: a multicenter cross-sectional survey |journal=European Review for Medical and Pharmacological Sciences |date=October 2022 |volume=26 |issue=19 |pages=7277–7284 |doi=10.26355/eurrev_202210_29921 |pmid=36263539 }}</ref> Some researchers claim this creates an environment that encourages greater vulnerability among patients in self disclosure in the practice of narrative medicine.<ref name="Schiffman"/> Telehealth allows for Zoom calls and video chats from across the world checking in on patients and speaking to physicians. Universities are now ensuring that medical students graduate with proficient telehealth communication skills.<ref>{{cite journal | vauthors = Thomas EE, Haydon HM, Mehrotra A, Caffery LJ, Snoswell CL, Banbury A, Smith AC | title = Building on the momentum: Sustaining telehealth beyond COVID-19 | journal = Journal of Telemedicine and Telecare | volume = 28 | issue = 4 | pages = 301–8 | date = May 2022 | pmid = 32985380 | doi = 10.1177/1357633X20960638 | doi-access = free }}</ref> Experts suggest that telehealth has become a vital part of medical care; with more virtual options becoming available. The pandemic era also identified the "potential to significantly improve global health equity" through telehealth and other virtual care technologies.<ref>{{Cite web | url = https://www.weforum.org/agenda/2023/01/telemedicine-global-health-equity-at-home-davos23/ | title = Telemedicine could help the world achieve health equity by bringing care to the home - here's how | publisher = [[World Economic Forum]] | date = 12 January 2023 | access-date=2023-01-12}}</ref>

== Telehealth versus in-person on treatment and follow-up visits study ==
A retrospective study in 2023 examining 1,589,014 adult primary care patients within an integrated healthcare system in the U.S. found that patients who initially had a telehealth visit were less likely to receive prescriptions, lab tests, or imaging compared to those who had an in-office visit. However, these same telehealth patients had higher rates of in-person follow-up visits. The study revealed that, out of the 2,357,598 primary care visits, 49.2% were in-office, 31.3% were telephone visits, and 19.5% were video visits. Office visits led to higher rates of prescriptions (46.8%), lab tests (41.4%), and imaging (20.5%) compared to video (38.4%, 27.4%, and 11.9%, respectively) and telephone visits (34.6%, 22.8%, and 8.7%, respectively). In contrast, patients who had telephone or video visits were more likely to have in-person follow-up visits, with 7.6% of telephone, 6.2% of video, and only 1.3% of office visit patients returning for primary care follow-up. Furthermore, rates of emergency department visits and hospitalizations were higher for those who had telemedicine visits, though these differences were minimal. The study's limitations include the inability to generalize findings to healthcare settings without telemedicine services or to patients without insurance or a primary care provider. The reasons for increased in-person healthcare utilization were also not captured, and long-term follow-up was not conducted.<ref>{{cite journal |last1=Reed |first1=Mary |last2=Huang |first2=Jie |last3=Somers |first3=Madeline |last4=Hsueh |first4=Loretta |last5=Graetz |first5=Ilana |last6=Millman |first6=Andrea |last7=Muelly |first7=Emilie |last8=Gopalan |first8=Anjali |title=Telemedicine Versus In-Person Primary Care: Treatment and Follow-up Visits |journal=Annals of Internal Medicine |date=October 2023 |volume=176 |issue=10 |pages=1349–1357 |doi=10.7326/m23-1335 |pmid=37844311 |pmc=11382601 }}</ref>

== See also ==
{{Portal|Medicine|Technology|Telecommunication}}
{{colbegin|colwidth=30em}}
* [[Artificial intelligence in healthcare]]
* [[American Telemedicine Association]]
* [[American Well]]
* [[Center for Telehealth and E-Health Law]]
* [[Connected health]]
* [[eHealth]]
* [[In absentia health care|''In absentia'' health care]]
* [[Mercy Virtual]]
* [[mHealth]]
* [[Myca]]
* [[National Rural Health Association]]
* [[Mixed reality#Healthcare|Data sharing between doctors through mixed reality headsets]]
* [[Remote therapy]]
* [[Ronald S. Weinstein]]
* [[Smart city]]
* [[Tele-epidemiology]]
* [[Teladoc]]
* [[Telecare]]
* [[Telemedicine service providers]]
* [[Telemental health]]
* [[Teleneuropsychology]]
* [[Telenursing]]
* [[Telepathology]]
* [[Telepsychology]]
* [[UNESCO Chair in Telemedicine]]
{{colend}}

== References ==
{{Reflist}}

== Further reading ==
{{refbegin}}
* {{cite web | url = http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_131689.pdf | work = UK Department of Health Whole System Demonstrator Programme | title = Headline Findings | date = December 2011 }} Results from clinical trial carried out by the UK Government's Department of Health
* {{cite web | url = http://tie.telemed.org/articles/article.asp?path=consumer&article=tmcoming_nb_tie96.xml | title = Telemedicine, Telehealth, and the Consumer | work = Telemedicine Information Exchange }} Online introduction and primer to telehealth and telemedicine
* {{cite book | vauthors = Norris AC | date = 2002 | title = Essentials of Telemedicine and Telecare | location = West Sussex, England; New York | publisher = John Wiley & Sons, Ltd. | isbn = 0-471-53151-0 }}
* {{cite book | vauthors = Maheu MM, Whitten P, Allen A | date = 2001 | title = E-Health, Telehealth, and Telemedicine: A Guide to Start-up and Success | location = San Francisco | publisher = Jossey Bass | isbn = 0-7879-4420-3 }}
* {{cite book | vauthors = Olmeda CJ | date = 2000 | title = Information Technology in Systems of Care | publisher = Delfin Press | isbn = 978-0-9821442-0-6 }}
* {{cite web | vauthors = Burgess SG | url = http://www.nrharural.org/pubs/pdf/Telehealth.pdf | title = Telehealth Technical Assistance Manual | access-date = 2008-03-03 | archive-date = 2008-04-10 | archive-url = https://web.archive.org/web/20080410001627/http://www.nrharural.org/pubs/pdf/Telehealth.pdf }} - A document to assist in the planning of telehealth and telemedicine projects for rural community and migrant health centers and other health care organizations.
* {{cite web | url = http://www.baaske.net/index.php?id=37&L=1 | title = Teleneurology and requirements of the European Medical Devices Directive (MDD) | work = Telemedical Systems and regulatory affairs for Europe | vauthors = Gärtner A | access-date = 2009-04-02 | archive-date = 2012-02-16 | archive-url = https://web.archive.org/web/20120216103855/http://www.baaske.net/index.php?id=37&L=1 }}
* {{cite journal | vauthors = Gilman M, Stensland J | title = Telehealth and Medicare: payment policy, current use, and prospects for growth | journal = Medicare & Medicaid Research Review | volume = 3 | issue = 4 | pages = E1–E17| date = 2013 | pmid = 24834368 | pmc = 4011650 | doi = 10.5600/mmrr.003.04.a04 }}
{{refend}}

== External links ==
{{Wikiversity|Clinician Telepsychology Guide}}
{{Wikiversity|Helping Give Away Psychological Science/Telepsychology Guide for Patients}}
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