Q. What is Telemedicine?
Q. What is the best way to start in Telemedicine?
Q. Does a Physician need to have a background in Telemedicine to provide Telemedicine services?
Q. Will insurance cover a Telemedicine visit?
Q. In-person Doctor visit vs. Telemedicine visit, which is better?
Q. If a patient would rather see a Psychiatrist over Telemedicine instead of locally in town, how do they find one?
Q. Does it matter if I get DSL at download/upload speeds of 128, 256, 1.5 mb?
Q. What are the top 3 current uses of Telemedicine?
Q. Are there some medical procedures that don't work well using Telemedicine?
Q. What are the pros and cons in switching to High Definition in Telemedicine video conferencing?

Q. What is Telemedicine?

Q. What is the best way to start in Telemedicine?
A. Ideally, you want to become informed as much as possible. Before you start, I highly recommend attending a Telemedicine Learning Center like the U.C. Davis Telemedicine Learning Center in California or a similar program located close to you. You can start with our Telemedicine Provider Directory which will soon include Telemedicine Learning Centers around the world. If you do not have the luxury of attending a program or there aren't any classes scheduled in the near future, you should at minimum contact a consultant with extensive hands-on experience, such as Telemedicine.com.

Get involved in the Telemedicine Discussion Forum here on our website to talk to other medical professionals around the globe and learn from their mistakes to help you succeed. You will quickly find that Telemedicine professionals enjoy helping each other overcome the barriers to become successful.

It's very unfortunate to see a site that had great enthusiasm and grant dollars supporting it to simply fail because they did not perform the initial needs assessment (type of equipment, telecommunications, infrastructure, staffing, and the operations) necessary for success. Most of the time, facilities move too quickly into Telemedicine specialties that are beyond their capabilities. This mistake can be costly for the success of the project. It is very important to have an immediate success and win to sustain the enthusiasm and drive from the team and slowly move into the more difficult procedures.

So the main thing is; do your homework, talk to others, develop your team and operations plan, and then begin with the easiest of Telemedicine procedures in your hospital, like Psychiatry for example.

Q. Does a Physician need to have a background in Telemedicine to provide Telemedicine services?
A: No, but it does help to have a Physician providing Real-Time (live) Telemedicine services who possesses a personable persona. If Telemedicine consultations are done over video, the Physician should be someone that speaks clearly and is not afraid to be on camera. A good criteria for selection of your Telemedicine Services Physician is someone that is motivated and excited by and not fearful of technology, especially if Store and Forward or Home Health Telemedicine is your main usage model.

Q. Will insurance cover a Telemedicine visit?
Q. In-person Doctor visit vs. Telemedicine visit, which is better?
A. It depends on the specialty, the physician, the patient, and the location. Let me explain.

When I first started deploying Telemedicine systems over 10 years ago, I actually felt guilty about going to rural towns to set up Telemedicine Psychiatry, wondering, "who will ever want to divulge their deepest, darkest secrets to doctor in a TV set?"

Because we were grant-funded, we had to keep evaluations on this program. When we received the results, I was amazed that the number of positive evaluations was through the roof. I decided that I had to read these evaluations to find out why patients were giving us such high grades. After reviewing them, I found that in these small towns patients repeatedly stated that if they visit a Psychiatry office, everyone in a small town sees your car and knows where you are and what you are doing. With Telemedicine, patients visit their General Practitioner which could mean they could be there for any of the 30-40 specialties offered with full anonymity.

Another big factor patients mentioned was that it is more difficult to open up and unleash everything to a local Psychiatrist because they thought they might see him at a grocery store or driving around town. Using Telemedicine, they were talking with a Psychiatrist at a remote site, so they felt more able to talk about all issues.

Also within dermatology consultations, I've heard from Specialists which noted that because you are using medical peripherals with multiple time zoom lens, you can actually see the image better over video that you can with the human eye, but this magnification is not always necessary for all dermatology consultations.

On the other side of the fence, in cases such as neurology, see question (Q10).

Q. If a patient would rather see a Psychiatrist over Telemedicine instead of locally in town, how do they find one?
A. The best way to find a Telemedicine Medical Provider is to look at our Provider Directory here or send us an email if we currently don't have a provider listed in your area and we will do our best to help you find one.

Q. Can I visit a Telemedicine Provider in any state in the U.S.?
A. The answer to that is yes; if you reside outside the USA. Due to state licensure issues, a physician can only practice medicine in the state in which they are licensed. However, your specialist could work through your local physician by offering several solutions allowing your physician to make the final recommendation and prescribe your treatment. As these laws continually evolve, check with your provider and specialist, as well as your insurance company for current laws and regulations.

Q. Does it matter if I get DSL at download/upload speeds of 128, 256, 1.5 mb?
A. First of all, in real time Telemedicine, you must be aware of the weakest common denominator which is the slower upload speed. Most DSL packages offer a much higher download speed than upload speed. Video is a full duplex technology, meaning video is sent and recieved continously so you cannot have different upload and download speeds otherwise the call will drop. Even if your download speed is 1.5 mb but your upload speed is 256k, you will have to connect at 256k or less.

One of the biggest challenges of the internet is even if you pay the much higher price for 6 mb upload/download speed and I pay much less for 256k, we in theory could still travel the same speed on the internet. Think about it this way, if you own a Ferrari and I'm in a Volkswagen Bug, but the traffic on the freeway is standstill or slow going, we both could still only travel at the same speed, even though your car in essence can go much faster. Your DSL speed is only guanteed from your location to the internet but cannot guarantee that speed once you are on the internet. Think of your DSL connection as a private freeway onramp directly from your house to the freeway but the internet is the actual freeway. Your onramp will be free and clear however you have no control of the amount traffic on the actual freeway.

In locations where the entire state or country is controlled by one phone company, you don't have nearly the problems because that one company can control your QOS (quality of service) throughout the entire link.

Q. What are the top 3 current uses of Telemedicine?
A. Radiology, Dermatology, and Psychiatry

Q. Are there some medical procedures that don't work as well using Real-Time (Live) Telemedicine?
A. Some neurological consultations such as trying to determine the finite movement of a tremor could sometimes not be as accurate over video as compared to in person. This is due to video compression and frame rates of the live Telemedicine consultations. In order to reduce the need for extremely high network bandwidths video systems compress the image by redrawing only significant areas of movement on the screen and/or a set number of refreshed frames known as key frames. Without getting too technical, standard video is made up of 30 still picture frames per second and compression throws out a number of picture frames every second which could make a tremor you see over video not as bad as it truly is in real life due to the loss of those picture frames.

However, with the advances in technology I have a feeling that we will soon have something like a glove the patient will wear which will generate a representation in data vs. visual to measure the degree of a tremor.

Great question. A lot of sites are currently going through this exact concern. There are a couple of issues you really need to take into consideration before moving forward. The first being, do you already have video-based telemedicine systems within your organization and what is the specialty you plan to support with this new high definition system?

Q. What are the pros and cons in switching to High Definition in Telemedicine video conferencing?

A. If you already have non-high definition systems in place and you purchase high definition systems which you will connect to your existing systems, the image will actually be much worse than if you continue to use only your legacy standard definition systems.

Let me explain, without getting too technical, standard definition video-based systems resolution is made up of an average of 480 lines of video screen information. Your new high definition system is either 720 lines or 1080 lines of resolution based upon the system you purchased. When these two different types of resolution systems, one being 480 lines of screen information (Standard Definition), connect to the other which is 720 or 1080 lines (High Definition), where do these extra lines of information magically come from? Your high definition system has to make up these lines by doing what's called line doubling to make up for the difference. Your standard definition system now has to delete lines of resolution because it’s going from 720 or 1080 lines of resolution down to 480. Since Telemedicine requires the best image possible, this is a big miscalculation.

The other main issue is the majority of medical peripherals still only are standard definition which causes the same problem as described above. If you have no pre-existing systems or medical peripherals, would I recommend purchasing high-definition systems throughout an organization at this time? Yes, only in the specialties such as cornea transplant or pathology, where the higher definition is noticeably increased as well as needed in these specialties. However, in order to take full advantage of the higher resolution, you need to be sure that all video systems, video monitors, and the medical peripherals, such as the microscope (pathology) are all high definition. If you are doing psychiatry, sports medicine, etc., in my opinion, it's overkill unless you are fortunate enough to have the extra funds for high definition. Another thing to consider is that even if your purchase all high definition systems you don’t want to mismatch 720 based systems with 1080 systems otherwise you will notice the issue described above as well.