The terms telehealth, telemedicine, virtual care and digital health are often used interchangeably, but that doesn’t mean they should be.

Hari Eswaran and Leah Dawson, two researchers at University of Arkansas for Medical Sciences, found that these terms often have different meanings for various stakeholders, such as providers, academics and federal agencies. Presenting the findings of their study at HHS’ National Telehealth Conference held virtually on Tuesday, Eswaran said understanding how different stakeholders use telehealth terms is key to effectively communicating about the care modality, a crucial consideration as its permanent coverage status remains undetermined.

Telemedicine has been historically used to describe healthcare at a distance, and telehealth is a term that gained popularity in the 1990s, according to Eswaran. He described telemedicine as a subset of telehealth, meaning telemedicine refers specifically to remote clinical care, whereas telehealth can refer to remote non-clinical services. He also noted that digital health is a larger umbrella term that encapsulates both telehealth and telemedicine.

In their research, Eswaran and Dawson found that legislators use the terms telemedicine and telehealth interchangeably. Healthcare organizations had distinct meanings for the two terms 76 percent of the time, and academic research had distinct meanings 60 percent of the time.

The study also found variance among the definitions used by federal agencies. For example, the Health Resources and Services Administration defines telehealth as the use of electronic information and telecommunication technologies to support long-distance clinical healthcare, patient and professional health-related education, public health and health administration. The agency has a separate definition for virtual care, which it describes as the use of technologies, such as telehealth, remote patient monitoring and self-management tools, driven by artificial intelligence and machine learning.

To compare, CMS defines telehealth, telemedicine and related terms such as virtual care as generally referring to the exchange of medical information from one site to another using electronic communication to improve a patient’s health.

Further complicating how these terms are received, some providers and legislators may include technologies like wearables and remote patient monitoring in their definitions of telehealth and digital health. In fact, wearables and ubiquitous health sensors are on track to become a larger part of digital health, said Elizabeth Krupinski, director of the Southwest Telehealth Resource Center. She pointed out that tech giants like Amazon and Google are some of the biggest innovators in the space, marking yet another stakeholder group where telehealth terms may have varying definitions. 

As these technologies continue to evolve and gain prominence in the health technology market, it becomes more imperative that providers and organizations be intentional about the terms they use when advocating for permanent telehealth coverage.

“You need to know who your audience is and you want that to be reflected in the definition you use,” Eswaran said.

His words come as healthcare providers and patient advocates continue to push the federal government and private payers to extend telehealth reimbursement beyond the pandemic-prompted emergency that propelled its adoption nationwide. This makes it imperative for providers and other advocates working with legislators to clearly identify which services are being recognized as telehealth for reimbursement and avoid any chance of misunderstanding, Eswaran recommended.

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