How Can Different Medical Specialties Collaborate Through the Use of Telemedicine? - Digital Optometrics

How Can Different Medical Specialties Collaborate Through the Use of Telemedicine?

Telemedicine is a multi-faceted technological approach in the delivery of health services. Healthcare institutions, individual specialists, and other healthcare providers can leverage digital communication technologies to deliver high-quality health services that mainly come in the form of video conferencing, asynchronous electronic transmission of patient data, and remote patient monitoring systems.

Specialists can integrate a telemedicine program into their practice to implement innovative solutions or to address a recurrent issue in the delivery of health services, but one of the least explored applications of telemedicine is specialist collaboration. Collaborative telemedicine is both a tool and a path for efficient delivery of quality care.

Telemedicine and Collaborative Practice

Collaborative and team-based care are interchangeable terms used to describe a care or practice scenario wherein there is patient care coordination across different specializations and health care settings. The main goal of this collaborative effort is to first and foremost, provide high-quality care through a multi-discipline approach. This increases the efficiency and value of care with positive and cost-efficient outcomes.

But even with the benefits, there are also several barriers that prevent the success of many collaborative, interprofessional care setups. These barriers can occur within the organizational level down to the team level. Proper coordination is one of the most common issues in collaborative care, especially among specialists that practice outside organizational bounds or geographic areas.  Most of the time, the issue of coordination isn’t only between specialists but also with patients, their families, and/or other clinical staff assigned to their care.

This is where telemedicine enters. Telemedicine enables specialists to coordinate and work in a collaborative environment irrespective of their geographic location. As telemedicine leverages digital communication technologies, it allows for communication and direct interaction with healthcare team members and patients that were otherwise impossible.

Telemedicine and the Role of Nurses in Collaborative Care

Nurses, along with physician assistants (PA) often serve as the primary care providers for remote care locations. It’s not surprising since nurses, in particular, are training to work in a collaborative environment from the very beginning. This is especially true in hospital settings where nurses need to work alongside a healthcare team. Though many healthcare and medical profession education curriculum include interprofessional collaboration, nurses have more experience in direct patient care within the context of the continuum of care.

In the context of telemedicine, nurses serve a vital role in the frontline of the service. Even in a regular healthcare setting, nurses are available even rural and underserved communities. Telemedicine will allow nurses to facilitate a patient’s access to the necessary specialists in a timely and cost-effective manner.

Benefits of Telemedicine for Team-Based Care

Even on its most basic application, telemedicine provides benefits that revolutionized the healthcare industry. But the use of telemedicine as a collaborative tool is an often-underappreciated advantage.

Whether you are optometrist wanting to bridge the gap and collaborate with an ophthalmologist or primary care physician wanting to establish a virtual healthcare team, here are the benefits you can reap from collaborative telemedicine:

  • Improve internal team communication as well as team-to-patient communication. Telemedicine technology enables healthcare teams to seamlessly coordinate patient care, access patient data, monitor patient progression all in one interactive platform. This structured approach in communication helps maintain the timeliness of vital communication and transparency. Telemedicine can also encourage both members of the team and patients to become more open in sharing their opinions, concerns, or suggestions.
  • Bridge service delivery gaps and addressing specialty scarcity. Geographic accessibility is one of the main issues in public healthcare in general. There is a considerable number of patients that live in rural or underserved areas. Most of them only have access to basic healthcare services. For these patients, accessing specialty and urgent care often means traveling for hours, returning for test results, or even returning regularly for chronic disease management. Telemedicine removes the gaps and barriers in accessing specialty care while also allowing smaller hospitals to address specialist shortages.
  • Remove the risk of health service fragmentation. Fragmentation occurs when primary care physicians, specialists, and other healthcare providers fail to coordinate a patient’s care. This is very risky as one specialist may not have full access to the patient’s medical history or current prescriptions. Fragmentation also poses a threat of high care costs for healthcare organizations.

Telemedicine removes this risk through care coordination, an organized patient information database, and highly accessible communication channels.

  • Optimize the efficiency of collaborative practice. Successful collaboration, coordination, and delegation is important in ensuring the continued efficiency of healthcare teams. Collaborative telemedicine solutions can help optimize collaborative processes while maintaining the dynamics of the practice.
  • Decrease cases of unnecessary patient transportation. There had been several studies on the inappropriate use of hospitals’ emergency resources for cases that receive belated assessment in triage as non-emergency. This default transportation to the emergency department (ED) results in overloading in the care system. In Texas, the Houston Fire Department established the Emergency Telehealth and Navigation (ETHAN) program to provide physicians the opportunity to virtually evaluation low-risk patients. The result of the evaluation will determine whether the patient will necessitate emergency transport or not.
  • Telemedicine solutions are flexible and are adaptable to different clinical specialties and subspecialties. It’s not just a matter of technological compatibility; telemedicine solutions have high compatibility to both individual practice and organizational process needs. The trends in telemedicine adoption and integration shows varied implementations of common use cases and also applications in different specialty processes.

Several of these applications include tele-optometry, telestroke networks, online psychiatry, telenocturnist care (nighttime telemedicine service), telerehabilitation, teledermatology, and telemedicine consults (specialist referrals).

  • Improves the service delivery experience. Telemedicine scores high on satisfaction levels for healthcare service delivery. This satisfaction level isn’t limited to patients’ impression and experience of telemedicine services but also applies to the providers’ overall experience in providing high-quality remote care services. Telemedicine services scored really high on convenience and accessibility especially for patients with chronic illness.

Challenges of Collaborative Telemedicine

A majority of challenges in team-based telemedicine is similar to the many challenges in normal collaborative practice settings. But the element of technology calls for a different regulatory approach that in many states, are primary challenges in telemedicine, in general.

  • Standardization of telemedicine rules and regulations. There is still confusion on the differing (sometimes even contradicting) state laws and regulations governing telemedicine solutions. Most of the time, there are limits on the portability or reciprocity of telemedicine-related licenses across states. Some states require providers to acquire a conditional license to practice telemedicine in a different state. This is especially an issue with Advanced Practice Nurses since the regulation on the practice is on a state level.
  • Insurance coverage and reimbursements. It’s almost impossible for some specialists to integrate telemedicine into their practice because of provider reimbursement and insurance coverage limitations. There are often limitations and restrictions to the types of telehealth services that Medicaid covers – in different states. Medicare covers the most common types but they have strict requirements on the services’ originating sites. These originating sites are predefined and do not include patient homes so home health monitoring services are out of the question, so as services rendered on rural areas that are not designated as rural and underserved areas. Private payer reimbursement is also regulated and mandated on a state-level.

There is also an issue on parity. There are still states that did not enact any telemedicine parity laws that enable equal rates for in-person and telemedicine visits.

  • The risk of vicarious liability suits. This refers to the liability of an employer (or someone with a supervisory position) for the actionable conducts of either an associate or subordinate. The collaborative nature of team-based care often blurs the line when it comes to the chain of command. There is no clear employer-employee relationship but most of the time, courts consider the grounds for liability on a case-to-case basis.


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