Is There a Difference between Telemedicine and Telehealth?
Scenario 1: At home with a sore throat, you connect with a physician by phone or web for a diagnosis and possibly a prescription.
Scenario 2: You’re in the hospital, where you are diagnosed by a remote physician via web connection.
Which scenario is telehealth and which is telemedicine, or does either term apply to each? Why does it matter?
To be technically correct, Scenario 1 is telehealth—a broad term describing any health services that are provided by telecommunications technology, quite often to consumers in their homes. Scenario 2 is telemedicine—a more specific term that applies to the clinical application of remote technology. That is, it occurs in a clinical environment, most likely a hospital, with the support of other clinical staff, diagnostic equipment and access to patient health records. Using these definitions, telemedicine is actually only one of many varieties of telehealth.
Two Distinct Terms are used Interchangeably
Sounds fairly simple, right? However, as telehealth and telemedicine gain wider use, the line between the two terms has blurred. Though it notes the distinction between the two terms, the World Health Organization (WHO) uses the terms interchangeably. In its 2009 report titled “Telemedicine: Opportunities and Developments in Member States,” the WHO has this to say: “Some distinguish telemedicine from telehealth with the former restricted to service delivery by physicians only, and the latter signifying services provided by health professionals in general, including nurses, pharmacists, and others.”
The American Telemedicine Association also considers telehealth and telemedicine to be interchangeable terms, while carefully pointing out the clinical environment where telemedicine is typically performed. “Telemedicine is the natural evolution of healthcare in the digital world,” the ATA states on its website. “ATA largely views telemedicine and telehealth to be interchangeable terms, encompassing a wide definition of remote healthcare, although telehealth may not always involve clinical care. Yet, regardless of how you refer to it, what is now indisputable is how telemedicine greatly improves the quality, equity and affordability of healthcare throughout the world.”
Confusion at the Public Policy Level
The interchangeability of telemedicine and telehealth causes confusion in the realm of health policy. As the Center for Connected Health Policy (CCHP) points out, definitions of telehealth differ among state and federal agencies. For example, California law defines telehealth as:
“The mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.”
Meanwhile, the federal Health Resources and Services Administration (HRSA) defines telehealth much more broadly:
“The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.”
As CCHP states: “These varying definitions influence the policies and regulations surrounding how telehealth is allowed to be used, and these policies vary as much across states as the definitions themselves.”
Telehealth’s Four Modalities
Determined to be the voice of clarity in the telemedicine vs. telehealth discussion, the CCHP has a very clear definition on its website of the different types of modalities in telehealth that go beyond the standard clinical definition of telemedicine:
- “Live video (synchronous): Live, two-way interaction between a person (patient, caregiver, or provider) and a provider using audiovisual telecommunications technology. This type of service is also referred to as “real-time” and may serve as a substitute for an in-person encounter when it is not available.
- Store-and-forward (asynchronous): Transmission of recorded health history (for example, pre-recorded videos and digital images such as x-rays and photos) through a secure electronic communications system to a practitioner, usually a specialist, who uses the information to evaluate the case or render a service outside of a real-time or live interaction. As compared to a real-time visit, this service provides access to data after it has been collected, and involves communication tools such as secure email.
- Remote patient monitoring (RPM): Personal health and medical data collection from an individual in one location via electronic communication technologies, which is transmitted to a provider (sometimes via a data processing service) in a different location for use in care and related support. This type of service allows a provider to continue to track healthcare data for a patient once released to home or a care facility, reducing readmission rates.
- Mobile health (mHealth): Health care and public health practice and education supported by mobile telemedicine communication devices such as cell phones, tablet computers, and PDAs. Applications can range from targeted text messages that promote healthy behavior to wide-scale alerts about disease outbreaks, to name a few examples.”