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Suggested Citation:"Appendix A: Definitions." Institute of Medicine. 2012. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13466.
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Appendix A

Definitions1

Asynchronous is a term sometimes used to describe store and forward transmissions of medical images or information because the transmission typically occurs in one direction at a time.

Digital Imaging and Communication in Medicine (DICOM) is a standard for communications among medical imaging devices; a set of protocols describing how images are identified and formatted that is vendor dependent and developed by the American College of Radiology and the National Electronic Manufacturers Association.

Distant site is defined by CMS as the telehealth site where the provider/ specialist is seeing the patient at a distance or consulting with the patient’s provider. Other common names for this term include hub site, specialty site, provider/physician site, and referral site. This site may also be referred to as the consulting site.

Hub site, see distant site.

Internet protocol (IP) is the protocol by which data are sent from one computer to another on the Internet. Each computer on the Internet has at least one address that uniquely identifies it from all other computers on the Internet. IP is a connectionless protocol, which means that there is no

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1 These terms are as defined by the American Telemedicine Association, and do not represent any consensus of the participants of this meeting on their definitions (ATA, 2012a,b).
Suggested Citation:"Appendix A: Definitions." Institute of Medicine. 2012. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13466.
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established connection between the end points that are communicating. The IP address of a videoconferencing system is its phone number.

Mobile telehealth (mHealth) is the provision of health care services with the assistance of a van, trailer, or other mobile unit in which the health care provider might provide patient services at a distance from a normal medical facility. Services may also be provided through mobile technologies that allow a mobile vehicle equipped with medical technologies to attach to an existing health care facility.

Originating site is defined by CMS as where the patient and/or the patient’s physician is located during the telehealth encounter or consult. Other common names for this term include spoke site, patient site, remote site, and rural site.

Remote patient monitoring is the use of devices to remotely collect and send data to a monitoring station for interpretation.

Spoke site, see originating site.

Store and forward (S&F) is a type of telehealth encounter or consult that uses still digital images of a patient for the purpose of rendering a medical opinion or diagnosis. S&F also includes the asynchronous transmission of clinical data from one site (e.g., patient’s home) to another site (e.g., home health agency, hospital, clinic).

Telemedicine and telehealth both describe the use of medical information exchanged from one site to another via electronic communications to improve the patient’s health status. Although evolving, telemedicine is sometimes associated with direct patient clinical services and telehealth is sometimes associated with a broader definition of remote health care services.

Videoconferencing is the real-time, generally two-way transmission of digitized video images between multiple locations; this uses telecommunications to bring people at physically remote locations together for meetings.

Suggested Citation:"Appendix A: Definitions." Institute of Medicine. 2012. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13466.
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Page 133
Suggested Citation:"Appendix A: Definitions." Institute of Medicine. 2012. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13466.
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Page 134
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In 1996, the Institute of Medicine (IOM) released its report Telemedicine: A Guide to Assessing Telecommunications for Health Care. In that report, the IOM Committee on Evaluating Clinical Applications of Telemedicine found telemedicine is similar in most respects to other technologies for which better evidence of effectiveness is also being demanded. Telemedicine, however, has some special characteristics-shared with information technologies generally-that warrant particular notice from evaluators and decision makers.

Since that time, attention to telehealth has continued to grow in both the public and private sectors. Peer-reviewed journals and professional societies are devoted to telehealth, the federal government provides grant funding to promote the use of telehealth, and the private technology industry continues to develop new applications for telehealth. However, barriers remain to the use of telehealth modalities, including issues related to reimbursement, licensure, workforce, and costs. Also, some areas of telehealth have developed a stronger evidence base than others.

The Health Resources and Service Administration (HRSA) sponsored the IOM in holding a workshop in Washington, DC, on August 8-9 2012, to examine how the use of telehealth technology can fit into the U.S. health care system. HRSA asked the IOM to focus on the potential for telehealth to serve geographically isolated individuals and extend the reach of scarce resources while also emphasizing the quality and value in the delivery of health care services. This workshop summary discusses the evolution of telehealth since 1996, including the increasing role of the private sector, policies that have promoted or delayed the use of telehealth, and consumer acceptance of telehealth. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary discusses the current evidence base for telehealth, including available data and gaps in data; discuss how technological developments, including mobile telehealth, electronic intensive care units, remote monitoring, social networking, and wearable devices, in conjunction with the push for electronic health records, is changing the delivery of health care in rural and urban environments. This report also summarizes actions that the U.S. Department of Health and Human Services (HHS) can undertake to further the use of telehealth to improve health care outcomes while controlling costs in the current health care environment.

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