What is considered telehealth?
‘Telehealth’ is a broad, multi-faceted, term that can mean different things to different people. For some, it may simply be known as the act of renewing a prescription by phone and for others, it may mean remote, complex, robotic surgery. So, what does and doesn’t count as ‘telehealth’?
Taxonomic problems like these are common in new fields, especially when they’re related to technology. Given a few years, the terminology will settle down, and we will agree upon a useful set of words to describe the different flavors of telehealth. But there is work to do now, so it’s worth exploring the vocabulary, even if it is imperfect, to gain an insight into the field and how it is progressing.
To do that, we’ll need to turn to one of the most enduring and pervasive inventions of the 19th century, the Venn Diagram (slightly unrelated: John Venn is also responsible for another, lesser-known invention: a machine that could bowl cricket balls at a professional level).
At the most basic level, we can say that telehealth is at the intersection of “tele,” which means remote or distant, and “health.” In other words, telehealth occurs anytime the participants are not in the same place at the same time. Note that the participants may be a patient and a caregiver, or the telehealth episode may occur between two providers — as in the case of consulting with a specialist. For our purposes, we’ll assume that electronic technologies are used to support communication over the distance.
Although it is narrower than telehealth, telemedicine is still a very broad term. Just as medicine is divided into specialties, so is telemedicine.
Once we start talking about tele-specialties, such as telepsychiatry, it’s possible to think about what such a program might look like. A practical conversation about telemedicine needs to focus at the specialty level. Only there, can reasonable plans be made regarding technology, policies, workflow, integration requirements, etc. Certainly, some of this can be generalized across specialties, but the work needs to proceed from the bottom up.
In addition to telehealth and telemedicine, there are two other related concepts: eHealth and mHealth.
Electronic Health (eHealth) pertains to electronically supported health care, whether it is at a distance or not. For example, clinical decision support (CDS) systems fall into this category. eHealth will be a growing area, as more and more computerized systems start to adopt features based on artificial intelligence.
Mobile Health (mHealth) refers to health and medical activities enabled by mobile technologies. A simple example would be an in-home primary care visit conducted by two-way video with a tablet or mobile phone. Health care is trailing every other industry in terms of being conveniently available to consumers on their handheld devices, and as technology and reimbursement policies change, we’ll see mHealth gain in popularity.
Putting it all together, we can completely map out the telehealth space, as AHRQ did in their Telehealth Evidence Map.
There are two key takeaways from this exploration of tele-terminology. First, make sure everyone you’re talking to agrees on the definitions; otherwise, there’s too much opportunity for misunderstanding. Second, start from the bottom up. There’s more clarity when the focus is on a tele-specialty compared to the more general concepts.