For the uninitiated, telemedicine is the use of telecommunications techniques for the purpose of enhancing medical diagnoses, expediting research and improving the treatment of illnesses at, or to, remote sites. Put more simply, it is the use of communications equipment as everyday as the telephone or as sophisticated as a satellite to treat patients who lack access to the health care they need.

Some of its applications include: •rural health care •aging populations •academic medical centers/community hospital links •military health care •managed care systems •prison health care •trauma network

Telemedicine has actually been around since the early 1960s, but new technology , such as high-speed, fiber optic telephone lines have increased its usage and honed its reliability by leaps and bounds. Its economic benefits are starting to be counted, as well. The use of telemedicine can decrease patient out-of-pocket expenses and hospital in-patient days, while increasing revenue for primary care providers and creating a possible revenue stream for a remote site.

Telemedicine uses advanced communication and computing technology to facilitate doctor/patient interaction, remote diagnosis and treatment, and the transmission of medical data and images. A result of the convergence of computing and telecommunications technologies, telemedicine is an effective way to provide convenient, quality access to medical care, allow closer collaboration among medical professionals, and lower the escalating costs of healthcare.

MMS has revolutionized the delivery of telemedicine services by consolidating high quality teleconferencing with a powerful multimedia medical imaging system and a contextually sensible patient record. Our systems were designed with input from renowned clinicians and administrators from Stanford, University of Virginia, Emory, Vanderbilt, National Institute of Mental Health, Center for Disease Control, and other leading institutions. MMS has experience implementing telemedicine solutions used in providing connectivity between rural and urban hospitals, military facilities, university medical centers, private research institutes, and managed care facilities.

The International Telemedicine Center, Inc. (ITC). ITC provides consulting services, workshops and seminars as well as support for your projects in the field of telemedicine. This organization offers: Consulting Services for clients; WORKSHOPS and seminars about telemedicine; PAPERS AND PRESENTATIONS and article written by ITC staff and related links; ITC STAFF personal web sites; ITC NEWS about ITC and its sister corporation International Telemedicine Network; TELEMEDICINE LINKS and related links for conferences, vendors, programs by area, correctional, literature, etc.; ITN AND ITPA International Telemedicine Network and Physician Association, a strategic partner with ITC.

Plans have asked if they can provide telemedicine services under Medicare Health Maintenance Organization (HMO) or Competitive Medical Plan (CMP) contracts under Section 1876 of the Social Security Act. Telemedicine is most commonly used in teleradiology and telepathology but is increasingly desired for consultations and for other specialty applications such as cardiology, dermatology, pathology and psychiatry.

Section 1876 of the Social Security Act and related regulations at 42 CFR 417.440 permit risk contracting organizations to make services not normally covered by Medicare available to its enrolled Medicare population. Telemedicine services may be offered by the managed care plan to its enrollees in the same manner as other services not covered by Medicare. For example, a risk contracting has the choice of offering telemedicine services as an additional service or a mandatory supplemental service as a part of the basic benefit package or as an optional supplemental service.

A recent book by the American Bar Association Tort and Insurance Practice Section (TIPS) offers lawyers basic information on managed care liability and strategies for effectively handling the complex issues involved in such cases.

Managed Care Liability: Examining Risks and Responsibilities in a Changing Health Care System reviews theories of managed care liability and cutting-edge issues that have put managed care liability cases at the forefront of health care law. The guide looks at how managed care cases are altering courtroom strategies, based on actual trial experience and post-verdict juror interviews. It identifies critical documents that can make or break the case for either side and offers a glimpse of health care in the future, including the impact of telemedicine.

Telemedicine, in one form or another, has been practiced for over thirty years. At the simplest level, a nurse providing clinical advice over the telephone is telemedicine. Today, however, we think of telemedicine applications that employ advanced image as well as audio capabilities. These technologies can range from high resolution still images (e.g., x-rays) to sophisticated interactive teleconferencing systems. Telemedicine now has the potential to make a difference in the lives of many Americans. For example, telemedicine can improve the delivery of health care in America by bringing a wider range of services such as radiology, mental health services and dermatology to communities and individuals in underserved urban and rural areas.

Private third party payers, including managed care plans, have been reluctant to pay for telemedicine services. And federally-funded programs such as Medicare and Medicaid provide limited coverage. Without adequate payments, the long term survival of telemedicine is in question. Thus, understanding the barriers to third party payment and how to overcome them has been a high priority for the JWGT.

Medicare's current coverage for telemedicine is limited to those telemedicine applications where, under conventional health care delivery, face-to-face contact is not required between patient and physician. Thus, Medicare covers teleradiology as well electrocardiogram (ECG), and electroencephalogram (EEG) interpretations.

Medicare's current coverage for telemedicine is limited to those telemedicine applications where, under conventional health care delivery, face-to-face contact is not required between patient and physician. Thus, Medicare covers teleradiology as well electrocardiogram (ECG), and electroencephalogram (EEG) interpretations.

In an effort to contain rising health care costs within this rapidly growing system, the Texas legislature established a Correctional Managed Health Care Plan in 1993 as a health maintenance organization (HMO) for inmates in its prison system. The HMO provides all inmate health services except mental health and substance abuse programs.

During a 3-month telemedicine pilot demonstration feasibility project from December 1992 to March 1993, 437 consultations were completed. Informal data from this demonstration revealed high levels of satisfaction with telemedicine among inmates and providers. On the basis of this finding, it was decided to utilize a multiphase plan to introduce telemedicine as an integral part of the prison health care delivery system.

Five topical areas were investigated: patient care, technology, support systems, evaluation, and nonclinical applications. Although we did not expect to obtain answers to all questions under each topic, it was considered necessary to identify the important questions at this stage of development in order to define the central issues that will face the program in the long run.

Telemedicine, the application of telecommunications technology to health care, requires the integration of technology, tools and training with medical care practices and problems. Although it is not necessary to be an expert in all these components to effectively use a telemedicine system, only through cooperation among health professionals, computer system developers, telecommunication providers, and educators can telemedicine achieve its potential to improve the delivery of health care, particularly in rural or remote areas.

Many computer and telecommunications technologies exist that can enhance health care. However, it is essential that health-care professionals take the time to learn about the possible applications of these technologies and their usefulness in the proper circumstances. It is also important that technologists and scientists in the computer and telecommunications fields learn to work with people in the health-care industry and educate them about these possibilities, while learning about the technology with which theirs will be integrated. By developing the appropriate technology and tools in cooperation with trained health-care personnel, it is clear that great improvements in the delivery of medical services to rural and remote areas can be made.

Efforts to encourage physicians and other health professionals to establish practices in rural under served areas have been only partly realized. Many western states continue to look for solutions to the problems of access to and quality of health care for rural citizens, particularly when health professionals are not available in rural communities.

Although not a panacea, telemedicine holds great promise to enhance health care delivery in rural areas by allowing a physician or other health professional to examine a patient while linked by video or other means to an expert consultant at a distant medical center. Radiologists and other specialists can review medical images transmitted over telephone lines. And university-based pathologists can review biopsies done in a rural hospital while the patient is still under anesthesia. Without telemedicine, these services would require travel on the part of either the patient or the consultant, or would simply not be available at all.

Increasingly, electronic transmission of other clinical information, including real time physiologic data and live two way interactive video communication, makes possible many of the same functions of clinical examination, consultation and treatment that can be done when patient and physician are located in the same place. These technologies are most commonly used to make clinical consultation available to an area that otherwise would not have access to special expertise. Many forms of therapy can also be provided or directed through telemedicine, and the technology is well suited to medical and health care administration.

So far, only teleradiology has been approved by HCFA for full Medicare reimbursement. This is because it is clear that whether he or she reads the original image or a faithful reproduction of that image at a remote location does not affect the nature of the radiologist’s consultation. Reimbursement for other services is currently negotiated as a contract between participating institutions.