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Types of Telemedicine Specialty Consultation Services

A telemedicine specialty consultation service is one that provides care to patients or advice to other medical providers in a particular medical subspecialty or healthcare specialization where the recipient of that service is located at a different geographic location from that of the provider. Typically, such services originate from health care systems, hospitals or large medical group practices that employ a diverse collection of expert and highly experienced medical and healthcare specialists. The specialists communicate with patients and/or providers at physically separate locations using a variety of communications and information technologies and tools to exchange medical information. These technologies may range from complex live, interactive videoconferencing with associated examination devices to simple image capture and transmission for storage and review. The specialist examines the patient, may or may not order additional diagnostic tests, may or may not provide direct treatment, but generally creates a consultation report for the referring physician. The specialist is typically reimbursed the same amount as if he or she had seen the patient in his or her own office.

What is a live, interactive video consultation?

A live, interactive videoconference consultation is one in which the specialist and the patient are present at the same time, but not in the same location. The specialist is often located either in a special telemedicine facility or in his or her office. The patient is at a different location, such as a clinic, nursing home or hospital, and may be accompanied by a telemedicine presenter, who is a staff member at that location. Communication is facilitated typically by using secure digital videoconferencing where the specialist’s image is captured by a video camera, digitized and transmitted over secure, broadband speed telecommunications lines to where the patient is located and where it appears on a video screen to be viewed by the patient. At the same time, the patient’s image is captured by a similar process and transmitted to a video screen for viewing by the specialist. The conversation between the patient and the specialist is captured and transmitted in the same way. The transmission speeds are sufficiently fast that the specialist and the patient can conduct conversations as if they were in the same room and hence the use of the descriptor “live, interactive” for these types of consultations.

What is a store-and-forward consultation?

A store-and-forward consultation is one in which information is captured from the patient at one time and location and evaluated by a specialist at another time and location. It derives its name from the fact that information is captured and “stored” in a digital file at one location and then transmitted or “forwarded” to another location for evaluation. Dermatology provides a good example of this type of consultation. In a dermatology store-and-forward consultation, a provider at a remote site typically takes digital pictures of the patient’s skin lesion with a digital camera and then uploads those images to a secure server along with other clinical information about the patient. At a later time, the dermatologist signs into that server, views the images and reviews the clinical information and writes a set of recommendations that are stored on the server. The referring physician or the original provider at his or her convenience can then sign into the server, review the recommendations and inform the patient of the results and any recommended treatments. Teleradiology is the most widely recognized and used type of store-and-forward consultation. As the longest-standing application of this type and to date the only one that is fully reimbursable, it has evolved into its own area of application and does not fall within the scope of this module.

What is a hybrid consultation?

Hybrid consultations are those that use components of both live, interactive and store-and-forward consultations. Typically, these are used in specialties such as dermatology or cardiology where higher quality images than those provided by standard video are important diagnostic tools and direct patient interaction is necessary. In pediatric cardiology, the specialist would use videoconferencing to observe the patient and to talk with the parents while viewing an echocardiogram that had been obtained by the technician just prior to the videoconference. A hybrid consultation has the advantage of making better use of all technologies that are available to diagnose and care for the patient and is not limited to a single communications channel.

What are the different kinds of specialty consultation services that are being offered today?

The following is a list of specialties and services that are often offered through telemedicine.

Specialty/Subspecialty

        Allergy/Immunology
        Anesthesia
        Cardiology
        Critical Care
        Dentistry
        Dermatology
        Otolaryngology (ENT)
        Emergency Medicine
        Endocrinology
        Family/General Practice
        Gastroenterology
        Infectious Diseases
        Internal Medicine
        Maternal/Fetal Medicine
        Mental/Behavioral Health
        Neurology
        Oncology/Hematology
        Ophthalmology/Optometry
        Orthopedics
        Pathology
        Pediatrics
        Psychiatry
        Pulmonology
        Rehabilitative Medicine
        Rheumatology
        Surgery
        Urology

Services

        Case Management
        Correctional telehealth
        Deaf/hearing services
        Diabetic retinopathy screening
        Dietician services
        Disease management
        Doctor-to-doctor consultation
        Enterostomal therapy
        Forensic/court services
        Genetic counseling
        Long-term Care
        Medication therapy management (MTM)
        Neonatal/Pediatric intensive care unit (NICU/PICU)
        Pain management
        Palliative care
        Pre/post-natal care
        Speech therapy
        Spine therapy
        Telestroke
        Wound care
        Adult, Individual and Group, Marital, Family and Sex Therapy
        Behavioral psychology and health (including mood, eating disorders)
        Chemical dependency aftercare (Addiction therapy follow-up)
        Chemical dependency therapy (Addiction therapy)
        Consultation to Schools
        Couples’ counseling
        Developmental (lifespan) counseling
        Psychiatric medication therapy management
        Psychological Assessment
        Psychological testing and interpretation
        Psychopharmacology
        Stress and health management

 

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