TeleHealthe-Our Newsletter

The TeleHealthe - Promoting TeleHealth through Information


Reimbursement for TeleHealth exists and is expanding constantly. Situations exist where traditional face to face medicine is simply not possible. Bringing speciality care to rural areas, delivering care to the homebound and providing post-care follow up can be greatly enhanced using TeleHealth solutions.

Due to the necessity of securing TeleHealth encounters, the growth of TeleMedicine has been slow. Voice and video chat software is readily accessible 
on the internet, however it rarely complies with the requirements for protected health information, rendering them invalid for TeleHealth applications. Proprietary systems are expensive, though many are vulnerable to compromise and intrusion. WebRTC changes all of that, since it requires no proprietary software or hardware, and inherently is immune from intrusion, eavesdropping or compromise. This makes WebRTC very attractive for TeleHealth solutions. 

The Centers for Medicare and Medicaid Services in the US reimburses many services delivered via TeleHealth. As with any federally reimbursable service, eligibility requirements exist, but many services are reimbursable under medicare. The CMS in November of 2014 decided that medicare payments for TeleHealth services would increase by 0.8%, at the same time they debated cutting payments for other services. 

The reimbursement strategy includes requirements for both approved "originating sites' (where the service originated from ) and approved "distant site practitioners" (who can deliver reimbursable services).

Qualified Originating Sites:

Generally, originating sites are:

The office of a physician or practitioner
Critical Access Hospitals
Rural Health Clinics (RHC)
Federally Qualified Health Centers (FQHC)
Hospital-based or CAH-based Renal
Dialysis Centers (including satellites
Skilled Nursing Facilities (SNF)
Community Mental Health Centers (CMHC)

Practitioners include:

Nurse practitioners (NP)
Physician assistants (PA)
Nurse midwives
Clinical nurse specialists (CNS)
Registered dietitians

Services that are reimbursable include::

Office or other outpatient visits
Individual psychotherapy
Pharmacologic management
Psychiatric diagnostic interview examination
End-Stage Renal Disease (ESRD)-related services
Individual medical nutrition therapy
Neurobehavioral status examination 
Follow-up inpatient telehealth consultations

A wide variety of services are covered in the States and fees are rising.
This makes TeleHealth an attractive option to improve healthcare delivery!

TeleHealthe-Our Newsletter

Edition #2, 24 June 2015


TeleHealth and the ambulatory surgical patient

Ambulatory surgery is a commonplace method for many surgical procedures. Both benefits and potential negatives exist, and reducing potential negatives is an important quality goal. The opportunity for clinicians to deliver postoperative visits, via a TeleHealth solution may be an attractive vehicle. A TeleHealth visit would eliminate patient travel time and expense. The elderly and those where travel is not feasible would also potentially benefit from TeleHealth. We take a look at the literature in this edition of the TeleHealthe.

Current Literature: 

In the the Journal of Telemedicine and Telecare (ref 1), the authors were able to realize both time and travel benefits for a group of pediatric surgical patients. In this study, the distance to the hospital was 330km, a substantial distance for the recently postoperative patient. Further, we can assume that often the same patient would not be able to operate a vehicle and many would need assistance to travel. The question then becomes is TeleHealth safe and will it be well received by the patient? A September 2013 study in JAMA Surgery (ref 2), looked at both complication rate and acceptance, for a group of 141 postoperative patients, who elected for TeleHealth in lieu of a visit to the clinic. This study showed that a Telehealth visit by an allied health professional can be safely and effectively used for postoperative care. There were no complications that resulted from the substitution of telehealth for a clinic visit, in this study. In this study, TeleHealth was performed via telephone. Therefore we do not know what impact, if any, the addition of video would have. 

Areas for further study:

We wonder about the impact video would have on postoperative wound care. Patients often have wound care questions and anxieties, and uncommonly (thankfully) complications. Traditionally, providers must rely on telephone descriptions to determine the seriousness of the problem. Would HD visualization have an impact? Currently, this is unknown. However, mounting evidence does exist in the dermatology literature, to support further investigation in the use of TeleHealth in postoperative wound care.


In summary, there is evidence based literature demonstrating the benefits of TeleHealth in the surgical patient. The literature does not suggest that this methodology induces complications and it was well received in trials. Studies clearly demonstrate time savings and  travel savings. This becomes very poignant for those at great distance, those for whom travel becomes honorous and those where travel is impossible. We certainly feel that additional studies are warranted, and attractive study possibilities truly exist. 

Subjects requiring further investigation:


We are confident that TeleHealth will stand up to the scientific rigors of protocol based study. Areas that we feel are critical for investigation:
  • Home Hospice
  • The Elderly and those with disabilities and major barriers to travel
  • Wound care
  • Rural speciality care
1)  2014 Dec;20(8):427-30. doi: 10.1177/1357633X14555610. Epub 2014 Oct 14
JAMA Surg. 2013;148(9):823-827. doi:10.1001/jamasurg.2013.2672

Custom development for Better Patient Care

We have been very busy at SysNetx working with our customers and improving our service. We have learned that making our service more flexible allows us to serve our clients better. This seems intuitive, though we often must adjust our workflow, to conform with the workflow of our software.

At SysNetx, we wanted to improve upon that convention, so we have spent the last few months learning how to better serve our public.

Software as a service (SaaS explained) can be greatly improved if it can integrate with the customers native platform (website, intranet, DB, etc...).

SysNetx embraces this concept, and has developed an API to facilitate integration with our clients infrastructure. This service allows secure calls to be made from the customer to our platform, and in a seamless manner integrate both services for a better user experience. This is really nothing more than the classic "Two heads are better than one" wisdom. Your medical practice, your EMR system and your customer relationship management system (CRM) can all be easily integrated with SysNetx, for an improved experience. Our engineers and clinicians will work with your IT team to develop a cost-effective, secure and reliable integration that remains relevant for years to come. You get the same great SysNetx services, the same highly secure platform, and seamless integration with your system(s). 


Features that our API delivers for you:

  • Secure, seamless integration with your EMR, EHR, CRM, Website and more....
  • "White Labeled" for your practice, company, institution, etc...
  • Simplicity in upgrades, updates and maintenance
  • Enormous flexibility to build the right solution for your workflow


SysNetx custom solutions deliver the great SysNetx service, Your Way!


SysNetx delivers simple tools for secure collaboration
Go to top