The Elusive Definition of Telehealth and Telemedicine

Federal agencies and industry have adopted varying definitions

Telemedicine globe stethoscope
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Telehealth is a rapidly evolving field with no universally accepted definition. This article will summarize definitions of telehealth and the related field of telemedicine as promoted by the U.S. government agencies as well as a large industry group.

Telehealth and Telemedicine According to the U.S. Government

Because the U.S. government has been instrumental in the development and advancement of telehealth for several decades, it is worthwhile to consider the definitions of telehealth and telemedicine espoused by federal agencies involved in the field.

Federal Telemedicine (FedTel) is a workgroup on telehealth comprised of over 100 volunteer representatives from agencies and offices across the U.S. government that have a significant stake in telehealth. In an article published in May 2014, Charles R. Doarn and colleagues described results of a survey of FedTel members undertaken to identify and evaluate the definitions of telehealth and telemedicine across U.S. federal agencies. Seven of the 12 FedTel agencies responded with a definition of telehealth. The seven agencies were U.S. Department of Agriculture (U.S.DA), U.S. Department of Commerce (DOC), U.S. Department of Defense (DOD), U.S. Department of Health and Human Services (DHHS), Federal Communications Commission (FCC), National Aeronautics and Space Administration (NASA), and Veterans Administration (VA). Note that DHHS includes several other agencies under its umbrella, but will be considered a single agency unless otherwise noted.

Results showed that federal agencies have adopted varying definitions of telehealth. The key commonalities and differences are described below:

All seven participating agencies considered telehealth to be the overarching concept, and telemedicine a subset. All agencies also agreed that health care services is included in the definition of telehealth.

However, the agencies differed on other themes to be included in definition of telehealth. Four agencies considered educational services to be a part of telehealth. Other themes included health administration, public health, and targeting a rural or underserved population -- with each theme endorsed by two or three agencies.

The five agencies that provided a definition of telemedicine agreed that telemedicine is a subset of telehealth. The also agreed that telemedicine refers to direct patient care. Key differences in definitions related to whether the patient care is delivered in real-time or asynchronously. For example, DHHS/ Centers for Medicare & Medicaid Services specified that telemedicine involves “Two-way, real-time interactive communication between the patient and the physician or practitioner at the distant site.” In contrast, the DOC/National Institute of Standards and Technology definition allowed for asynchronous communication, such as transmission of still images and patient portals.

A major aim of a bill introduced in the U.S. Congress (H.R. 3750,Telehealth Modernization Act of 2013) is to generate a “workable Federal definition of telehealth”

Telehealth and Telemedicine According to the American Telemedicine Association

The American Telemedicine Association (ATA) was established in 1993 as a non-profit organization comprised of individuals and organizations with a stake in promoting telemedicine throughout the world. The ATA considers telemedicine and telehealth to be interchangeable terms for remote health care. The organization acknowledges that telehealth is sometimes used to refer to remote health care that does not always involve clinical services, but uses the terms “in the same way one would refer to medicine or health in the common vernacular.”

The ATA defines telemedicine as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.” Within the organization’s broad definition, telehealth and telemedicine includes real-time and asynchronous interactions.


A universal definition of telehealth and telemedicine is elusive. But it is possible to envision an inclusive concept based on the varying definitions espoused by federal agencies and the ATA. It might look like this:

Telehealth is the use of telecommunications and information technology to provide health care services at a distance to rural, underserved, or other populations. Examples of health care services delivered via telehealth include direct patient care, education, health administration, and public health interventions. Services may be delivered asynchronously or synchronously (real-time).Telemedicine is the subset of telehealth which involves direct patient care or clinical services. The definitions will evolve as the field matures. Stakeholders may eventually reach a consensus on the definition of telehealth and telemedicine.

Read here about the major operational modes of telemedicine: store-and-forward, remote monitoring, and interactive telemedicine.


Text of the Telehealth Modernization Act of 2013. Accessed on June 25, 2014.

American Telemedicine Association. What is Telemedicine? Accessed on June 24, 2014.

Doarn CR et al. Federal efforts to define and advance telehealth--a work in progress. Telemed J E Health. 2014 May;20(5):409-18. Accessed on June 25, 2014.

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