Telemedicine, Telehealth, and Mobile Health Applications That Work: Opportunities and Barriers Ronald S. Weinstein, MD, a,b,c Ana Maria Lopez, MD, MPH, b,c,d Bellal A. Joseph, MD, b,e Kristine A. Erps, b Michael Holcomb, BS, b Gail P. Barker, PhD, b,c Elizabeth A. Krupinski, PhD b,f a Department of Pathology, College of Medicine-Tucson, Tucson, Ariz; b Arizona Telemedicine Program, College of Medicine-Tucson, Tucson, Ariz; c College of Medicine-Phoenix, Phoenix, Ariz; d Department of Medicine, University of Arizona College of Medicine-Tucson, Tucson, Ariz; e Department of Surgery, University of Arizona College of Medicine-Tucson, Tucson, Ariz; f Department of Medical Imaging, University of Arizona College of Medicine-Tucson, Tucson, Ariz. ABSTRACT There has been a spike in interest and use of telehealth, catalyzed recently by the anticipated implementation of the Affordable Care Act, which rewards efficiency in healthcare delivery. Advances in telehealth services are in many areas, including gap service coverage (eg, night-time radiology coverage), urgent services (eg, telestroke services and teleburn services), mandated services (eg, the delivery of health care services to prison inmates), and the proliferation of video-enabled multisite group chart rounds (eg, Extension for Community Healthcare Outcomes programs). Progress has been made in confronting traditional barriers to the prolif- eration of telehealth. Reimbursement by third-party payers has been addressed in 19 states that passed parity legislation to guarantee payment for telehealth services. Medicare lags behind Medicaid, in some states, in reimbursement. Interstate medical licensure rules remain problematic. Mobile health is currently undergoing explosive growth and could be a disruptive innovation that will change the face of healthcare in the future. Ó 2014 Elsevier Inc. All rights reserved.  The American Journal of Medicine (2014) 127, 183-187 KEYWORDS: Credentialing; Disruptive innovation; ECHO programs; Licensure; mHealth; Mobile health; Telehealth; Telemedicine; Telestroke; Reimbursement; Rural medicine SEE RELATED EDITORIAL p. 172 The impending rollout of the Affordable Care Act (ACA) is catalyzing a surge of interest in telemedicine, telehealth, and mobile health. The shifts of the healthcare industry into new directions to accommodate the goals of the Affordable Care Act initiative should expand the practice and provision of healthcare at a distance. Telemedicine, telehealth, and mobile health are important enabling technologies. 1-3 TELEMEDICINE, TELEHEALTH, AND MOBILE HEALTH Telemedicine allows clinical services to leverage informa- tion technologies, video imaging, and telecommunication linkages to enable doctors to provide healthcare services at a distance. In contrast to telemedicine, which is narrowly defined as the provision of medical services at a distance by a physician, telehealth is an umbrella term that covers telemedicine and a variety of nonphysician services, in- cluding telenursing and telepharmacy. Mobile health is a newer concept that describes services supported by mobile communication devices, such as wireless patient monitoring devices, smartphones, personal digital assistants, and tablet computers. Mobile applications (apps) and, in some in- stances, companion mobile devices and sensors are the en- ablers of mobile health and the drivers of the systems. Meaningful use has specific requirements for patient engagement that can, in part, be addressed with mobile health technologies. SUCCESS FACTORS IN TELEMEDICINE Having a business plan is critical for success. Programs starting without recurrent sustaining revenue streams Funding: None. Conflict of Interest: None. Authorship: All authors had access to the data and played a role in writing this manuscript. Requests for reprints should be addressed to Ronald S. Weinstein, MD, Arizona Telemedicine Program, College of Medicine, University of Arizona, PO Box 245105, Tucson, AZ 85724-5105. E-mail address: rweinstein@telemedicine.arizona.edu 0002-9343/$ -see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.amjmed.2013.09.032 REVIEW