Telemedicine Overview and Application in Pulmonary, Critical Care, and Sleep Medicine

This book provides an overview of key issues with regards to implementing telemedicine services as well as an in depth overview of telemedicine in pulmonary, critical care, and sleep medicine. Topics range from specific practices to program development. Telemedicine has experienced explosive growth in recent years and yet, implementing telemedicine solutions is complex with substantial regulatory, legal, financial, logistical, and intra-organization/intra-personal barriers that must be overcome. This book provides the necessary information and guidance to address those complex issues.

This book is broadly divided into two parts 1) a primer on requisite steps before embarking on telemedicine service development and 2) specific applications and examples where telemedicine is successfully utilized to improve quality of care in pulmonary, critical care, and sleep medicine. The first part includes coverage of telemedicine and finance, regulatory and legal issues, and program development. The second part delves into specifics with information on ambulatory telemedicine programs, inpatient consultations, and tele-ICU programs. All chapters are written by interprofessional authors that are leaders in the field of telemedicine with extensive knowledge of diverse telemedicine programs and robust real-world experience on the topic.

This is an ideal guide for telehealth program managers, and pulmonary, critical care, and sleep medicine professionals interested in improving their telehealth practice.

Section 1: Primer on telemedicine program development

I.              Overview and history of telemedicine

b.    What is and is not telemedicine

c.    Modes of telemedicine delivery

II.            Regulatory and legal issues

a.    Licensing and Credentialing

b.    Medical malpractice and Liability

c.    Informed consent

e.    Legislation to consider (i.e. Stark Law, Anti-Kickback, Anti-Trust and Safe Harbors)

f.     Documentation

III.           Telemedicine and finance

a.    State parity legislation (pros and cons)

b.    Medicare, Medicaid, and Third-party payers

c.    Successful business models

2.    Professional billing

3.    Direct-to-Patient (out-of-pocket)

                                         ii.    Indirect Revenue streams

1.    Downstream revenue (e.g. surgery cases)

2.    Global or bundled payment

                                        iii.    Other value cases

1.    Reduce readmission penalties

2.    Improve patient compliance and outcomes

d.    Return on investment

e.    Health system investment

IV.          Intra- versus Inter-organizational issues in telemedicine program development

a.    Aligning telemedicine services with needs

b.    Communication between providers

V.            Telehealth services framework

a.    Telehealth strategy

b.    Telehealth design

c.    Telehealth transition

e.    Continual quality improvement

VI.          Technology and data system considerations

a.    Telemedicine platforms

b.    Information technology

c.    Communication technology

d.    Data systems

a.    Adoption and utilization

b.    Tele-presenters

c.    Inter-professional communication

VIII.        How telemedicine can support high quality care

a.    Safe

b.    Effective

c.    Patient-centered

d.    Timely

e.    Efficient

f.     Equitable

   Section 2: Application of telemedicine in pulmonary, critical care, and sleep medicine

a.    School based telemedicine for pediatric asthma

b.    Home based COPD management

d.    Multi-disciplinary lung cancer tumor board via telemedicine

    II.        Emergency department based consultations

   III.        Inpatient consultations

  IV.        Tele-ICU programs    

a.    Distinguishing characteristics of tele-ICU medicine

b.    Review of the literature on tele-ICU

c.    Pediatric critical care telemedicine

Dee W. Ford

Medical University of South Carolina

Charleston, SC, USA

Shawn R. Valenta

Medical University of South Carolina

Charleston, SC, USA