Telemedicine allows health care professionals to evaluate, diagnose and treat patients at a distance using telecommunications technology. The approach has been through a striking evolution in the last decade. The expectation for more convenient care, combined with the unavailability of many overburdened medical professionals (especially primary care providers) have made telemedicine an increasingly important part of the American healthcare infrastructure. In much of the healthcare industry, the terms “telehealth” and “telemedicine” are often used interchangeably since their definitions encompass very similar services. However, more technically speaking, Telemedicine is a subset of Telehealth. Telehealth is a collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technologies, while Telemedicine refers specifically to clinical services. For example, a mobile app that lets physicians treat their patients remotely via video-chat falls under the Telemedicine category.

The Telemedicine Industry

The global telemedicine market size was valued at USD 24.9 billion in 2016 and is expected to reach $113.1 Billion at a CAGR of 18.3% by 2025. The growth of the market is likely to be driven by increasing adoption of telemedicine, rising incidences of chronic diseases, growing geriatric population, government initiatives, and shortage of physicians amongst others. Virtual medicine is benefiting in reducing the emergency room visits and hospitalization rate, thereby augmenting the market growth. The telemedicine market is segmented on the basis of products, and region. The service offers prime channel for various providers to communicate on the same platform and thus, centralize all the available data.

Benefits

1. Saves on healthcare costs - The US spends $2.9 Trillion on healthcare every year. However, $200 million of those costs are avoidable.
   
2. Extends access to consults from specialists - Helps expand access to niche medical specialists, despite their location.
   
3. Increasing patient engagement - Allows patients to connect with their doctor more frequently. Thus, strengthening patient-doctor relationship and empowering patients to manage their care.
   
4. Better quality patient care - Facilitates remote extensive monitoring of the patient
   

So why are consumers hesitant to use telemedicine?

A survey at the end of 2017 demonstrated that 82% of U.S. consumers do not use telemedicine. The hesitance to utilize telemedicine stems from a variety of reasons.

1. Lack of awareness - People are not aware that they have the option of consulting with their physician via the internet.
   
2. Ambiguity around insurance compliance and insurer reticence - Patients heard of telemedicine apps often fear the expense, especially if it's unclear whether they can use their health insurance.
   
3. Uncertainty about the quality of the doctors - Doctors who are willing to work with app makers are inexperienced, or low-quality.
   
4. The need for in-person reassurance - even in the digital age, a lot of people simply want to see their doctor in person. They're not Luddites. But sick, vulnerable people often need in-person reassurance from another human being in the room.
   

Telemedicine Specialties

Telemedicine is used in many different medical fields, as every medical field has some use for consulting a specialist remotely. Due to the limited access to medical care, especially in some rural areas, telemedicine proves to be very useful for healthcare providers trying to expand access to quality patient care. Some of the most prominent telemedicine specialties include:

Teleradiology

Many ER patients have to wait for a diagnosis of their X-ray during off-hours since most small hospitals around the US do not have diagnosticians on-call at all times. Teleradiology allows providers at one location to send a patient’s x-rays and records securely to a qualified radiologist at another location, and get a quick consult on the patient’s condition.

vRad (Acquired by MEDNAX for $500M) is one of the leading providers of remote diagnostic image interpretation, or teleradiology, services in the United States. According to Frost & Sullivan, they are the second largest provider of teleradiology services in the United States. 

Telepsychiatry

Telepsychiatry allows qualified psychiatrists to provide treatment to patients remotely, expanding access to behavioral health services. Telepsychiatry is incredibly popular, in part because of the nation-wide shortage of available psychiatrists, and because psychiatry often does not require the same physical exams of the medical field.

Regroup Therapy, Inc. ($13.9M total funding) provides telemedicine solutions to eradicate mental healthcare shortages across the USA. It allows mental health professionals to virtually meet with patients at a variety of institutions.

Breakthrough Behavioral ($11.7M total funding) connects people with mental health providers for online counseling and telepsychiatry. Clients can search for providers on multiple criteria, schedule appointments, and get private, online care. Members of Breakthrough-partnered health plans may use their insurance to cover the cost of care.

Teledermatology

Teledermatology solutions are usually store-and-forward technologies that allow a general healthcare provider to send a patient photo of a rash, a mole, or another skin anomaly, for remote diagnosis. As frontline providers of care, primary care practitioners are often the first medical professionals to spot a potential problem.

3Derm ($3.5M total funding) is a cost-effective, skin imaging system that allows non-dermatologists to take clinical-quality 3D skin images remotely. With 3Derm, dermatologists can review images taken at medical kiosks and other referral sites to efficiently monitor high volumes of patients’ lesions while reserving in-office appointment times for those patients whose images indicate a more alarming condition.

Teleoncology

The teleoncology field has quickly expanded in the last few years, to provide more accessible and convenient care to patients with cancer. While some teleoncology solutions offer store-and-forward tools to forward images for diagnosis, others are live video platforms to allow patient consults with the oncologist. Many telemedicine platforms offer these services.

Eagle Telemedicine'sTeleOncology solution provides remote access to skilled oncologists and allows hospitals to meet patients’ needs instead of transferring them to another location. Some of the critical services provided are hematology and oncology consultations, genetic counseling, palliative care assistance and cancer treatment reviews.

Telemedicine Today: Making healthcare more convenient

Telemedicine was originally created as a means to reach patients in remote places. However, as telemedicine is increasingly becoming a tool for more convenient medical care, Many companies offer patients 24/7 access to medical care with an on-call doctor contracted by that company. Examples of prominent companies within this industry include:

1. HealthTap: HealthTap ($88.3M total funding) offers the world’s most comprehensive Virtual Care Cloud™, running on their proprietary Healthcare Operating System (HOPES™), and powered by their doctor-trained artificial intelligence (Dr. A.I.™). HealthTap makes  their basic services available to everyone for free while providing enterprises such as health systems, insurers, and employers with a connected healthcare ecosystem. 
   
2. American Well: American Well ($210.1M total funding) is a company based connects users instantly with doctors over video feed. The company's mobile and web service connects doctors with patients for live, on-demand video visits over the internet and handles all the administration, security, and record keeping services.
   
3. MDlive: Founded in 2006, MDLIVE ($73.6M total funding) is a leading telehealth provider of online and on-demand healthcare delivery services and software that benefit patients, hospitals, employers, payers, physician practice groups and accountable care organizations.
   
4. Doctor on Demand: Doctor On Demand ($160.7M total funding) is the next-generation video telemedicine company, offering on-demand and scheduled visits with US-licensed healthcare providers (psychologists, urgent care physicians and pediatricians) via any smartphone, tablet, or computer. 
   
5. Pager: Pager ($29.6M total funding) is a leading digital-health technology and solutions company that engages patients with a single point of entry to access the healthcare system in a simple, fast and convenient consumer experience. Pager acts like a "doctor in your pocket" by consulting with a live clinician to address all of your health issues and insurance questions. Patients communicate via chat, voice or video using mobile, web or third-party platforms on a real-time synchronous basis.
   

Telemedicine has become critical to hospitals

Telemedicine is quickly becoming an essential part of the healthcare industry. “Consumers are clearly interested in more convenient access to healthcare – and increasingly, they are even willing to switch providers to get internet video service,” said Mary Modahl, American Well’s chief marketing officer. “Not only that, but consumers are willing to try telehealth for many needs – from chronic conditions to post-discharge follow up.”

In the ER

 The number of ER visits jumped 36 percent from 1995 to 2010 – from 97 million to 130 million – the number of ERs in the country dropped by 11 percent. This leads to more crowded EDs and longer wait times, and puts considerable stress on staff, patients and – ultimately – clinical outcomes. As a result, platforms that allow the health system to screen incoming patients, referring the life-threatening cases to onsite staff while either treating non-acute cases through telehealth or referring them to other services is particularly valuable. For example, the virtual visit platform, developed by the Wisconsin-based startup EmOpti, is currently being used in eight hospitals in four health systems: Wisconsin’s Aurora Health Care, MedStar in Washington D.C., Philadelphia’s Thomas Jefferson University Hospitals and Charlotte, N.C.-based Carolinas HealthCare. 

University of Mississippi Medical Center (UMMC) uses telemedicine platforms to help smaller hospitals treat more of their ER patients rather than transferring them to larger institutions. A study of 15 of the state’s hospitals using the UMMC telehealth platform to treat some 500,000 patients saw a 25% reduction in a hospital’s staffing costs, while the hospitals saw a 20% increase in admissions – patients who would have been transferred to UMMC for ultimately non-serious issues, depriving the local hospital of revenues and taxing UMMC’s resources.

In the ICU

There is a shortage of Intensivists in the United States, and the demand for them is only going to get worse with the aging population. As of 2010, less than 15% of Intensive Care Units (ICU) are able to provide intensivist care. Tele-ICU is the use of health information exchanged from hospital critical care unit to another via electronic communications. As a result, Tele-ICU holds great promise in improving the quality of critical care patients and increasing the productivity of intensivists. On the revenue side, one study indicated that there was a 10% reduction in ICU length of stay with ability to care for one new ICU patient per day which could result in a positive $2.5 M net present value (NPV). As a result, from the data available, Tele-ICU seems to be a promising path, especially in the United States where there is a limited number of board-certified intensivists.