What's the Difference Between Telemedicine and Telehealth?

One often hears the terms "telemedicine" and "telehealth" used interchangeably. While they are similar in many regards, there are noteworthy differences — differences that clinicians must understand so they can engage in meaningful discussions and planning concerning the roles telemedicine and telehealth may play in their efforts to improve the delivery of care.

Let's first define these terms.

What is Telemedicine?

The Federal Communications Commission (FCC) defines telemedicine as "… using telecommunications technologies to support the delivery of all kinds of medical, diagnostic, and treatment-related services, usually by doctors." The American Academy of Family Physicians (AAFP) defines telemedicine as "… the practice of medicine using technology to deliver care at a distance."

What is Telehealth?

The FCC states that telehealth is similar to telemedicine but "… includes a wider variety of remote health care services beyond the doctor-patient relationship." AAFP states telehealth "… refers broadly to electronic and telecommunications technologies and services used to provide care and services at-a-distance." The Center for Connected Health Policy (CCHP) identifies four different telehealth modalities: 1) live video; 2) mobile health; 3) remote patient monitoring; and 4) store-and-forward.

Examples of Telemedicine Activities

To further distinguish telemedicine and telehealth, let's discuss three example activities for each, beginning with telemedicine.

1. A 2018 American Medical Association survey showed that radiology has the highest use of telemedicine for patient interactions than any other medical specialty, reports Health Imaging. A Health Progress article describes "teleradiology" as follows: "… a CT is sent securely over the Internet, a report is generated and the treating physician gets a message. During a standard telemedicine encounter, a remote physician is notified that a patient is in the queue. The physician then reviews patient information from the electronic medical record, visits with the patient over phone or video, documents his or her findings, and communicates recommendations to the requesting physician. Except for minor differences based on specialty and video availability, the infrastructure is the same."
2. Kaiser Permanente physicians — including primary care doctors, pediatricians, mental health providers and emergency medicine doctors — engage in video visits with patients. Patients can take advantage of video interactions for a wide array of reasons, including follow-up care, sore throat, flu, cuts and wounds, eye problems, joint problems, and medication questions.
3. As a final example of a telemedicine activity, there's "teledermatology." As a NEJM Catalyst case study notes, the typical teledermatology process requires three main steps: 1) images are taken in a primary care office and uploaded into a technology system; 2) remote dermatologists review the images and share observations; and 3) primary care physicians review these consult reports and determine if dermatology appointments are necessary.

Examples of Telehealth Activities

Here are three example activities for telehealth.

1. A type of telehealth experiencing notable growth in adoption is "telepharmacy." As a U.S. Pharmacist report notes, telepharmacy essentially "… leverages technology to allow one pharmacist to provide supervision and review prescriptions at multiple locations. Patients pick up medications from a nearby licensed location staffed by pharmacy technicians and have access to the same counseling with a pharmacist at the remote location as they would at the home pharmacy, only it is done via a screen rather than in person."
2. Telehealth nursing is another function that's expanding, according to a Nursing2019 article. The article notes that telehealth nursing is a "… tool for delivering nursing care remotely to improve efficiency and patient access to health care." Telehealth nursing services include the ability to "… guide patients to emergency department visits, clarify appropriate treatment options, educate about self-care at home, and assist with appointment scheduling."
3. Finally, let's note the emergence of "telecare," a term more commonly used in Europe that is gaining traction in the United States. The FCC states that telecare "… generally refers to technology that allows consumers to stay safe and independent in their own homes."

While telecare often involves the use of more advanced technologies, such as apps, sensors, and other digital tools, one organization that leverages telecare in a simpler fashion is Minnesota's Winona Health. The organization describes its volunteer-based service as follows: "Telecare volunteers make daily phone calls, including weekends and holidays, to telecare clients. The phone call is a way for individuals who live alone to stay connected on a daily basis and know that someone will follow up if they are unable to get to the phone."

Further Distinguishing Between Telemedicine and Telehealth

Of the two terms, telemedicine is much older than telehealth. As the book "Telemedicine: A Guide to Assessing Telecommunications in Health Care" notes, "According to one review, the first reference to telemedicine in the medical literature appeared in 1950. The article described the transmission, beginning in 1948, of radiologic images by telephone between West Chester and Philadelphia, Pennsylvania, a distance of 24 miles."

Going back even further, as the book "The Role of Telehealth in an Evolving Health Care Environment" notes, "… an 1879 article in the Lancet talked about using the telephone to reduce unnecessary office visits. In 1925, a cover of Science and Invention magazine showed a doctor diagnosing a patient by radio, and within envisioned a device that would allow for the video examination of a patient over distance."

As the term telehealth has emerged in more recent years, some have chosen to merge the term with telemedicine, as discussed earlier. But others have worked to distinguish the two from one another, as we have in this blog. Here are few other examples of organizations and individuals explaining the differences between telemedicine and telehealth:

HealthIT.gov: "Telehealth is different from telemedicine because it refers to a broader scope of remote health care services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services."

AAFP: "Telehealth is different from telemedicine in that it refers to a broader scope of remote health care services than telemedicine. Telemedicine refers specifically to remote clinical services, while telehealth can refer to remote non-clinical services."

CCHP: "Telemedicine is often still used when referring to traditional clinical diagnosis and monitoring that is delivered by technology. However, the term telehealth is now more commonly used as it describes the wide range of diagnosis and management, education, and other related fields of health care." 

AARP blurs the lines even further by introducing a new term: "Also referred to as telemedicine or telehealth, 'virtual care' involves the remote diagnosis and treatment of patients by medical experts who are miles or even continents away."

How should your organization approach using these terms? The Telehealth Alliance of Oregon offers sound advice when it suggests that you "… use definitions that are easiest for your organization to understand and implement internally.  However, when working with other organizations, especially with regard to reimbursement, licensure or grants, it is important that you use the terms as they are defined by that organization."