Telehealth has been around for roughly 150 years, depending on how broadly you define it. The earliest documented case dates to 1874, when a surgeon in South Australia telegraphed wound care instructions to a patient 2,000 kilometres away. Of course, that looks nothing like a video visit with your doctor today. The technology and scale have changed dramatically, but the core idea of delivering medical guidance across a distance has a surprisingly long history.
Telegraph and Radio: The 1870s to 1920s
That 1874 telegraph exchange is the oldest known instance of remote medical care. It was a one-off, limited by the technology of the time, but it established the principle that a doctor didn’t always need to be in the same room as the patient.
By the 1920s, the practice had become more routine. Physicians around the world began using radio to evaluate, diagnose, and treat sick or injured people aboard ships at sea. Maritime medical consultations were a natural fit: ships could be weeks away from the nearest port, and radio was the only communication link available. This became one of the first sustained, practical applications of what we’d now call telehealth.
Live Video Arrives: The 1950s and 1960s
The leap from voice-only radio to real-time video happened faster than most people realize. In 1959, the Nebraska Psychiatric Institute began using closed-circuit television to conduct group therapy sessions, long-term therapy, and psychiatric consultations with patients at a state hospital about 100 miles away in Norfolk, Nebraska. The system also served as a training tool for medical students. This is widely considered the first interactive video consultation in healthcare, and it happened more than 60 years ago.
NASA and the Push Into Remote Monitoring
Space exploration gave telehealth a major technological boost. Before Yuri Gagarin’s first spaceflight in 1961, no one was sure the human body could even function in orbit. Both the U.S. and Soviet space programs strapped medical monitors onto animals and transmitted their biometric data back to Earth, creating some of the earliest remote patient monitoring systems.
By 1964, NASA had formalized this work into a program designed to support longer missions where astronauts couldn’t quickly return to Earth. The agency needed ways for non-physicians in space to perform at least basic guided medical treatment, with doctors monitoring and directing from the ground. That capability required better sensors, better data transmission, and better communication protocols, all of which fed directly into civilian telehealth.
The most notable spinoff was STARPAHC (Space Technology Applied to Rural Papago Advanced Health Care), a program NASA ran from 1973 to 1977 on the Tohono O’odham reservation in Arizona. Mobile units equipped with space-derived technology connected patients in remote areas to physicians at Indian Health Service hospitals in Sells and Phoenix. A 1974 NASA report called it “a necessary step” for improving healthcare delivery for both astronauts and ordinary Americans. STARPAHC proved that the same tools keeping astronauts alive could serve rural communities with limited access to doctors.
The Internet Changes Everything: 1990s to 2010s
For decades, telehealth required expensive, specialized equipment: closed-circuit TV systems, dedicated phone lines, custom-built mobile units. The internet and broadband changed that equation entirely. As DSL standards evolved through the 1990s and 2000s, data speeds increased and costs dropped, making it possible for ordinary clinics and eventually individual patients to participate in video-based medical visits without specialized hardware.
Still, adoption was slow. Insurance coverage was a major barrier. In 2012, only 16 states had laws requiring private insurers to cover telehealth visits. Doctors and patients were interested, but the reimbursement infrastructure hadn’t caught up. States gradually began passing parity laws requiring insurers to cover remote visits the same way they covered in-person ones. By the time the pandemic hit, 43 states and Washington, D.C., had some form of telehealth private insurance law on the books.
The Pandemic Surge and What Stuck
Before COVID-19, telehealth was a rounding error in American healthcare. Among Medicare patients, it accounted for just 0.1% of outpatient visits. Then, in April 2020, it exploded to 41.0% of those same visits. Regulations that had limited where patients could be located, which providers could bill for virtual visits, and whether phone-only calls counted were temporarily waived almost overnight.
Usage didn’t stay at those emergency levels, but it didn’t return to baseline either. Through 2023 and 2024, telehealth settled at roughly 5.7% to 7.0% of Medicare outpatient visits overall. The averages, though, mask enormous variation by specialty. In fields with low telehealth use, remote visits accounted for about 1.2% of appointments. In medium-use specialties, the figure was 8.4%. And in high-use specialties, primarily mental health, telehealth still made up 43.8% of visits years after the pandemic emergency ended.
Where Telehealth Rules Stand Now
The pandemic-era flexibilities didn’t become fully permanent. Many of them were extended through December 31, 2027, creating a window that will eventually close unless Congress acts. During this period, Medicare patients can receive telehealth services from anywhere in the country, including their homes, and a broader range of providers can bill for virtual visits. Audio-only phone calls also remain covered through that date.
Starting January 1, 2028, the rules are set to tighten significantly. For most non-behavioral-health services, Medicare patients would need to be located at a medical facility in a rural area to qualify for telehealth coverage. Physical therapists, occupational therapists, speech-language pathologists, and audiologists would lose the ability to bill Medicare for telehealth visits. Hospitals could no longer bill for services like diabetes self-management training delivered remotely to patients at home.
Behavioral health is the major exception. Congress permanently removed geographic and location restrictions for mental health and substance use telehealth visits. Patients in both rural and urban areas can receive behavioral health services at home, including through audio-only phone calls, with no expiration date. That permanence reflects how thoroughly telehealth has become embedded in mental healthcare: nearly half of all visits in high-use specialties are still conducted remotely.
Colorado offers one example of how states have pushed further, passing a 2020 law that prohibits insurers from requiring a previously established relationship with a provider before covering a telehealth visit. Federal law, however, limits how far states can go. Self-funded employer health plans fall under federal jurisdiction, meaning state telehealth mandates don’t apply to a large portion of the privately insured population.
150 Years in Perspective
Telehealth’s timeline spans from a single telegraph message in the Australian outback to a system that handled 41% of Medicare outpatient visits in a single month. The technology progressed through radio, closed-circuit television, NASA-engineered mobile units, and finally the internet. But the adoption story is just as much about policy and payment as it is about technology. The tools were available long before the rules and reimbursement structures caught up, and the pandemic compressed what might have been a decade of gradual adoption into a few weeks. Whether the current regulatory framework will preserve that shift or partially reverse it depends on decisions that are still being made.