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Using Telemedicine

(Digital Medicine; E-Health; Mobile Health)


Michael R. Wasserman

, MD, California Association of Long Term Care Medicine

Reviewed/Revised Apr 2023

Telemedicine is health care provided at a distance, usually over the telephone or internet. Although in-person visits have several advantages, telemedicine is a valuable alternative when in-person visits are unsafe or not feasible. Advances in technology have made it possible for doctors to interact with their patients when they cannot or should not meet in person.

Telemedicine involves the use of:

  • Telephone calls

  • Text messages

  • Emails (usually sent via a patient portal—a secure site where the patient's electronic records, including prescriptions, health history, and laboratory test results, are kept)

  • Video chats using the internet

Not all doctors are set up to provide telemedicine, and not all medical conditions can or should be treated remotely. (Telehealth is the term used to describe a wider range of nonclinical services used to support telemedicine.)

People need to have the equipment, services, and software necessary to use telemedicine. When arranging a telemedicine appointment, someone from the doctor's office should check that the patient has some or all of the following: a telephone, reliable internet service, and a smartphone or computer capable of supporting any applications the office uses to set up remote doctor visits. The doctor's office may ask the patient to test the connection before the virtual appointment takes place. The office may also establish a backup plan in case the primary connection fails. For example, a video chat may go awry if the audio or video fails, in which case it may be necessary to continue the session by phone. The person or a member of the health care team may need to visit the patient portal before the virtual appointment, either in advance or as part of the check-in procedure; sometimes it is done during the visit too.

Telemedicine can be useful for people who have

  • Limited access to health care, including those who live in rural areas or far from the doctor's office

  • Difficulty with movement, such as those with Parkinson disease or other mobility issues

  • Limited or no transportation

  • A disorder or situation (for example, a viral epidemic) that makes an in-person visit less safe

Some medical conditions are more suitable for telemedicine management than others. Chronic conditions that require frequent monitoring, including at-home readings, such as blood pressure and blood sugar, can often be managed using telemedicine. People can share and discuss the data they collect at home during a virtual appointment. They may also be able to log that data into their patient portal for the doctor to review before the appointment. The patient portal is useful in other ways. For example, people can request or obtain electronically stored health information from the patient portal instead of waiting for the doctor's office to call with the information. Some conditions such as specific rashes (for example, shingles) can be diagnosed using telemedicine video or transmitted photographs.

For doctors, telemedicine is useful for determining when an office visit is absolutely necessary. During a public health crisis that involves an infectious disease, such as the COVID-19 pandemic, health care facilities seek to limit the risk of exposure to health care practitioners and patients alike. Telemedicine gives the health care team enough advance warning to prepare to safely meet the needs of individual patients while adhering to protocols that protect the health care practitioners themselves as well as others. Doctors can help determine at a safe distance

  • If a condition needs no intervention (for example, the common cold or an asymptomatic or mild case of COVID-19)

  • If a condition needs to be confirmed by a test or treated in person (for example, a sore throat that needs to be cultured or a suspected case of COVID-19 that requires testing or treatment)

  • If a condition requires immediate or urgent care in a hospital setting

How to make the most of telemedicine

  • It is important to test the technology before the scheduled virtual visit. That way, there is time to resolve any problems.

  • It may be necessary for people to upgrade their technology to meet the demands of telemedicine (for example, by increasing their internet bandwidth).

  • It may help to make certain preparations for the specific visit (for example, taking and uploading photos of a skin rash)

  • No matter how well the technology works, a backup plan is important (for example, being prepared to complete an interrupted video session by phone).

At the end of a telemedicine session, the doctor or other health care professional may recommend that additional medical attention be provided in a more traditional office setting.

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