From New rules around when and how doctors can prescribe medication through telemedicine take effect in Florida today. The changes adopted by the Florida Board of Medicine say “prescribing medications based solely on an electronic medical questionnaire constitutes the failure to practice medicine.” While the prescribing of controlled substances are generally banned, doctors can still issue such medication to hospitalized patients. This is the third time this year the state has enacted changes to its telemedicine regulations. Also, the state clarifies that its telemedicine policies don’t apply in emergency situations. In March, the state allowed for a valid physician-patient relationship to be established though telemedicine. They recognize valid relationships can be established with physician assistants as well as physicians. View the rule and changes here:


Posted by: C3O Telemedicine News

Posted on: October 27th, 2014

Posted in:

A long-touted health-care revolution may at last be about to arrive

Stuck in the waiting room from The Economist

THE idea of telemedicine—health care provided using telecommunications equipment—has a lengthy history. Radio News, an American magazine, devoted its cover to a patient at home consulting a doctor in his surgery via a television link as long ago as 1924. When NASA began monitoring astronauts in space in the 1960s, fantasy became reality. It has been touted as health care’s future ever since.

But even smartphones and tablets have failed to usher in the telemedicine revolution: most health care still happens face to face. Now, enthusiasts think the wait is nearly over. Governments have been slow to embrace an approach that could improve coverage and outcomes, as well as saving money. But they are under increasing pressure from ageing populations and a surge in chronic diseases, just as public budgets are being squeezed.

At an industry conference in Rome on October 7-8th, participants discussed the problems that must be solved if telemedicine’s day is to come. They include redesigning laws and payment systems set up for face-to-face care, and finding ways to keep patients’ data secure and private.

In America, the world’s largest health-care market, states license doctors. Jurisdiction depends on the patient’s location, not the doctor’s—so doctors must be licensed in all states where they have patients, and meet care standards that René Quashie, a health-care lawyer, says are “complicated, incoherent and sometimes contradictory”.

The situation in the European Union is simpler: countries may not pass laws that would stop doctors practising telemedicine, and doctors need only be licensed in one country to practise in all. But member states do not agree on whether to pay for care that is administered remotely; some, including Germany, rarely pay for it at all.

In America only 21 states mandate that telemedicine be compensated at the same rate as face-to-face care. At the federal level, the Veterans Administration has embraced telemedicine whereas Medicare, the public-health programme for the elderly, largely ignores it. But private employers and insurers are increasingly paying for telemedicine, encouraged by a shift to paying doctors for packages of care rather than per service. This has “opened the door” to remote care, says Jonathan Linkous of the American Telemedicine Association.

Telemedicine is more than a Skype chat between doctor and patient, says Michael Young, who works on remote care for the University of North Carolina. The technology can look similar but the need for security and privacy is greater. Earlier this year the FBI warned American health-care providers that their cyber-security systems were not up to snuff. Electronic versions of sensitive documents such as X-rays or doctors’ notes must be as secure as paper ones. That is hard when they are flying through the ether. In August one of America’s biggest hospital groups said Chinese hackers had stolen data on 4.5m patients.

Some small countries are in the vanguard. Israel’s health-care system is fully digitised: all doctors use electronic medical records, and patients have access to their data. Doctors can write repeat prescriptions and refer patients to specialists over the internet. The health ministry noticed an uptick in telemedicine in 2010 and introduced relatively lax guidelines in 2012.

China is spending billions on health-care reform, with a focus on telemedicine. But keen interest is no guarantee of success in any country. “If you have a chaotic system and add technology, you get a chaotic system with technology,” says Peteris Zilgalvis, a health official at the European Commission. Telemedicine may even increase costs if it is added to old routines rather than replacing them. There is little evidence of its cost-effectiveness, says Marc Lange of the European Health Telematics Association, because studies simply lump it on top of standard care.

Lights, camera, interaction

Some doctors have been reluctant to embrace telemedicine, says Nils Kolstrup, a Norwegian doctor, fearing it may lessen their authority by making it easier for patients to seek advice elsewhere. Patients, too, may feel they are being fobbed off with second-best, and governments worry that it could stimulate frivolous demand.

So countries where provision is currently limited or non-existent may be quickest to move. Rwanda, for example, is short of oncologists, so American specialists consult on difficult cases. Doctors at the Cleveland Clinic look at tumours from several African countries. But if telemedicine is to take off, big, rich countries must embrace it—not least because that is where the money is.



Posted by: C3O Telemedicine News

Posted on: October 9th, 2014

Posted in:

ATA’s Jon Linkous and the “Telemedicine Advantage”

By  of US News & World Report:

You could say telemedicine keeps patients at a distance – but Jonathan Linkous prefers to say it keeps them close. During “The Telemedicine Advantage,” part of the U.S. News Hospital of Tomorrow forum, Linkous, chief executive officer of the American Telemedicine Association, described the myriad ways telemedicine is extending the reach of health care, particularly for people in rural areas who don’t have easy access to high-quality care.

More than half of U.S. hospitals use telemedicine to engage with patients remotely – from monitoring vital signs to full-fledged consultations at a distance. Just the flash of a webcam, for example, allows critically ill patients, perhaps in an eICU, access to a world-class team of physicians who could be anywhere from miles to states away.

Patients’ doctor visits of the future will, in many cases, involve facing a screen – and “in some emergency rooms in San Francisco, you can walk into a kiosk, answer a set of questions and your course of care will be decided by an algorithm in a computer,” said moderator Steven Sternberg, U.S. News’ deputy health rankings editor. “There’s a lot of ferment in the field,” and real obstacles along with benefits. Among the highlights of the discussion, which explored both:

  • Linkous said telemedicine has been around 20 to 30 years “depending how you define it.” Perhaps the greatest example: radiologists, who don’t need to be in the same hospital or even city as a patient to examine digital images. Telemedicine is in place in 100 to 200 networks around the country, and close to 1 million patients will receive consultations online via webcam this year. “And that’s just the small tip of the iceberg,” Linkous said. He added that remote monitoring – for stroke patients, for example – has “huge potential” and can lead to a lower cost of care, coupled with higher quality. “It’s somewhat controversial, but the truth is, consumers want it,” Linkous said. There’s evidence in studies, he added, which suggest that patients overwhelmingly accept telemedicine, and recognize that it’s a step to receiving better care.
  • Steven A. Fuhrman, eICU medical director at Sentara Healthcare – the first remote critical care facility in the nation – said that when his clinic launched in 2000, caring remotely for a critically ill patient was “met with big question marks on people’s faces.” But it’s led to more efficient decision making and has allowed staff to become more efficient in dealing with complex cases. It also promotes proactive care. So why was the ICU one of the first places to have a population-management approach to telehealth? Because it’s such a data-rich environment – and monitoring sends data to centralized location, where it can be interpreted. If you can’t picture an eICU, “We’re not a security camera-based operation,” Fuhrman said, adding that there aren’t hundreds of screens plastered across the hospital’s walls. While physician care revolves around video access, and the ICU staff is not present in the ICU where the patient is, there is bedside staff who helps facilitate care.
  • Robert L. Satcher Jr., an assistant professor of orthopaedic oncology at The University of Texas MD Anderson Cancer Center, said cancer will become the most common cause of death in the coming decades. And because of insufficient primary physicians and specialists to meet the demand for cancer care, especially in rural areas, MD Anderson says telemedicine will play an increasing role. “Many patients live a long way from Houston and are looking for ways to receive care without traveling to Houston,” Satcher said. “The demand for teleoncology is from both patients and physicians.” He added that patients are typically satisfied with the “convenient” experience. Videoconferencing can lead to effective communication between physician and patient, he said, but it remains to be seen how that communication compares to a face-to-face meeting. Meanwhile, telemedicine has appeared at MD Anderson in a number of ways, from telementoring to telesurgery – a limited number of surgical procedures have involved robotic systems. Still, there are concerns, including the high cost of robotic systems, billing issues, safety and infrastructure (for example, a delay in the transfer of information from one site to another). While telemedicine is “not an ell-encompassing panacea,” Satcher said, he described its tremendous potential in meeting patient and clinician needs and enhancing cancer care to underserved regions.


Posted by: C3O Telemedicine News

Posted on: October 7th, 2014

Posted in:

Reduction of readmissions for CHF by telemedicine

The Journal  Population Health Management reported that Telemonitoring provides a potentially useful tool for disease and case management of those patients who are likely to benefit from frequent and regular monitoring by health care providers. Since 2008, Geisinger Health Plan (GHP) has implemented a telemonitoring program that specifically targets those members with heart failure. This study assesses the impact of this telemonitoring program by examining claims data of those GHP Medicare Advantage plan members who were enrolled in the program, measuring its impact in terms of all-cause hospital admission rates, readmission rates, and total cost of care. The results indicate significant re-ductions in probability of all-cause admission (odds ratio [OR] 0.77; P < 0.01), 30-day and 90-day readmission (OR 0.56, 0.62; P < 0.05), and cost of care (11.3%; P < 0.05). The estimated return on investment was $3.30 on the dollar. These findings imply that telemonitoring can be an effective add-on tool for managing elderly patients with heart failure.


Posted by: C3O Telemedicine News

Posted on: October 6th, 2014

Posted in:

Telemedicine policy revisions of North Carolina Medical board

According to Church and Richardson of the JDSurpa Business Advisor:

The Policy Committee of the North Carolina Medical Board (“NCMB”) issued proposed revisions to its “Telemedicine” and “Contact with Patients before Prescribing” position statements on September 23, 2014. In short, the proposed revisions:

  • Clarify that there is one standard of care for providers based on their specialty, and telemedicine providers are subject to the same standard of care as non‑telemedicine providers;
  • Revise the standard regarding when telemedicine providers need not conduct an in‑person examination, such that the licensee need not conduct an in‑person examination if he or she “employs technology and peripherals sufficient to provide an examination that is equal or superior to an in‑person examination”;
  • Clarify that it is the telemedicine provider’s responsibility to verify the identity and location of the patient;
  • Specifically state that prescribing controlled substances for pain treatment via telemedicine is disfavored; and
  • Specifically add the potential for a more general ability for telemedicine providers to prescribe for a patient when not personally examining the patient by including language that prescriptions may be made “where the threshold information to make any accurate diagnosis has been obtained.”

The proposed changes are in follow up to an NCMB‑hosted roundtable discussion on August 20, 2014, to gather feedback from stakeholders—including private practitioners, academic medical centers, government officials, and insurers—regarding its current telemedicine position statement. The comment period is open until November 5, 2014.

Proposed Telemedicine Revisions

The NCMB has proposed revisions to the following subsections of the current position statement:

Standard of Care. The proposed revisions reemphasize that current standards of medical practice in North Carolina, as well as professional accountability and consequences for failing to meet such standards, apply equally to the traditional practice of medicine and the practice of medicine via telemedicine. This includes current standards regarding practice improvement and outcome monitoring.

In‑Person Evaluations Not Required When Examination is “Equal or Superior to an In‑Person Examination.” The NCMB has proposed to remove language that required an examination via telemedicine provide “the same information…as if the exam had been performed face to face,” and instead suggests that an physical examination would not be required if he or she “employs technology and peripherals sufficient to provide an examination that is equal or superior to an inperson examination.” This change raises a number of questions as to how this standard may be satisfied. In this regard, it is noteworthy that that the revisions to the position statement did not remove a statement that telemedicine may require another licensed professional to be available to provide physical findings in order to complete an appropriate assessment, again suggesting that information typically obtained via a physical examination may still be required.

Accordingly, while it could be interpreted that practitioners have more flexibility to determine treatment via telemedicine, it also provides a high standard for telemedicine providers to meet without specifying how such a standard would be satisfied.

Patient and Practitioner Identification. The revisions also propose to no longer require that a practitioner practicing telemedicine have “some means of verifying” patient identity, but rather simply require that a practitioner should both verify the identity and location of a potential patient and provide the patient his or her own name, location and professional credentials.

Prescribing. The proposed position statement contains a new “Prescribing” section, which requires practitioners to practice telemedicine in accordance with the NCMB’s prescribing policy (discussed further below) and specifically cautions practitioners that prescribing controlled substances via telemedicine for the treatment of pain is “disfavored.”

Medical Records. Proposed additions serve as a reminder that the current standards of care regarding communication and the transfer of medical records to a primary care provider or facility also apply to practitioners practicing telemedicine.

Contact with Patients before Prescribing

As in the telemedicine position statement, the NCMB statement on prescribing has traditionally emphasized the standard of care as the guiding principal with respect to prescribing medications. While the NCMB continues to state that prescribing under certain circumstances is inappropriate, the proposed changes include an acknowledgement that prescribing drugs to patients is permissible if an evaluation is performed “to the extent necessary for an accurate diagnosis.” In addition, the proposed changes would explicitly state that telemedicine is included in the list of examples of circumstances in which prescribing without an inperson, physical examination may be appropriate. Specifically, the proposed revisions allow “an appropriate prescription in a telemedicine encounter where the threshold information to make an accurate diagnosis has been obtained.” Again, this raises questions as to how such a standard might be met.


The NCMB appears to be opening the door for telemedicine providers to potentially be able to meet the standard of care without an in person examination (but rather, through the appropriate use of technology); however, at the same time, it is reaffirming that the standard of care is not different. Ultimately, this appears to place the responsibility squarely on practitioners to distinguish those situations in which treatment of a patient via telemedicine is appropriate based on a patient’s clinical presentation (and how such telemedicine occurs) and when it is not.

The short, yet significant, revisions to the prescribing position statement contemplate that prescribing for a patient with whom the practitioner has never had a facetoface visit may be permitted if the practitioner determines that sufficient information has been obtained. However, it leaves open the question as to what constitutes obtaining sufficient information.

Moreover, the NCMB specifically stated that prescribing controlled substances via telemedicine is disfavored. In addition, NCMB has not changed its position with regards to prescribing based solely on an Internet questionnaire or a telephone conversation, which the proposed statement still states is inappropriate.

In sum, the proposed revisions to both position statements potentially provide practictioners additional flexibility, but the premise remains unchanged: the use of telemedicine to treat and diagnose illness and prescribe to patients is appropriate in cases in which a practitioner determines that he or she can meet the standard of care and appropriately care for a patient from a distance, except when it involves controlled substances.

While flexibility will be welcomed by practitioners, clarity is equally important. Hopefully, following the comment period, the NCMB will attempt to draw more brightline standards.


The proposed revisions to the telemedicine and prescribing position statements can be viewed hereand here.

The NCMB is soliciting comments regarding the proposed revisions to both position statements. Comments may be emailed to Please indicate “telemedicine” in the subject line. Comments are due by the end of business on November 5, 2015.



Posted by: C3O Telemedicine News

Posted on: October 6th, 2014

Posted in:

Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life


While not under the sign of telemedicine, the Institute of Medicine just released a report on preferences at the End of Life.


Posted by: C3O Telemedicine News

Posted on: September 17th, 2014

Posted in:

Growth of telemedicine: new studies reviewed by CTel

 From CTel

As The Robert J. Waters Center for Telehealth and e-Health Law (CTeL) and others have previously reported, seemingly countless studies of recent have projected tremendous growth in the use of telemedicine in the years to come, particularly in the areas of remote monitoring and mHealth.  Yet still others have been more measured in their estimations, highlighting hesitancy among some providers and patients to adopt telehealth technologies.

The past few weeks have seen the release of several studies that have come to somewhat discrepant conclusions, including one from HIMSS Analytics, which points to somewhat limited provider adoption; one from Deloitte that forecasts a rise in telemedicine visits in the coming year; and still another from Towers Watson, which identifies an increased willingness among large employers to offer telehealth services to their employees, though utilization so far has been low.  Below, CTeL offers an overview of the three studies and their conclusions; essentially, based on this body of research, telemedicine—despite past and projected future growth—still has some maturing to do.

In its “2014 Telemedicine Study,” which surveyed health care providers, executives, and IT staff, HIMSS Analytics found that “telemedicine is becoming increasingly important to organizations both tactically and strategically,” including as a way to deliver cost savings and improve care coordination.  Yet only about half of providers are taking advantage, and the landscape remains complicated.  “The study found that organizational needs will vary based upon provider type while the numerous technologies under the telemedicine umbrella will add to the complexity of the market,” HIMSS Analytics Research Director Brendan FitzGerald explained in a news release.  FitzGerald, however, is optimistic about expanded utilization: “Regardless of these challenges, organizations will continue to look for and utilize technology to fill gaps and enhance initiatives in patient care.”

The Deloitte study, which focused on North America, also projects growth in telemedicine this year, estimating “up to 75 million telehealth visits in 2014, representing an increase of 400% over 2012 levels.”  Worldwide, the number may reach 100 million, fueled by provider shortages, expanded use of smartphones, and a number of newly insured patients.  “With 110 million office visits a year related to low-level conditions like sore throats, earaches, and skin rashes, these quick and efficient remote interactions could ease the burden of overworked primary care providers with little time to spare,” EHR Intelligencer’s Jennifer Bresnick sums up in her discussion of the researchers’ findings, pointing also to new legislation designed to address regulatory barriers.  However, “providers will need to be educated about the value of remote consults if telehealth is to succeed.”

Finally, the Towers Watson researchers highlight the potential savings that telemedicine can deliver, noting also that more and more large employers are choosing to embrace it.  “Thirty-seven percent of employers surveyed said that by 2015 they expect to offer their employees telemedicine consultations as a low-cost alternative to emergency room or physician office visits for nonemergency health issues, and another 34% are considering offering telemedicine for 2016 or 2017,” the company said in a news release accompanying its study of large U.S. employers.  Yet currently, “utilization is low,” often coming in at “less than 10%.”

Still, employers appear increasingly enthusiastic, given the potential to save money.  As health care consultant and blogger Jane Sarasohn-Kahn sums up of the study’s results, “Employers could save over $6 billion if industry replaces virtual health consultations with face-to-face visits at doctors’ offices, emergency rooms, or urgent care centers.”  For her part, Sarasohn-Kahn appears to be a firm believer in telemedicine.  “The beauty of telehealth, from a health-economic standpoint, is that it scales from [one] to many,” she asserts.  “As we seek to conserve health costs in a resource-constrained health environment, telehealth can scale primary care—which is needed for bolstering the American primary care infrastructure.”



Posted by: C3O Telemedicine News

Posted on: September 3rd, 2014

Posted in:

The New Face Of Healthcare Innovation: 7 Ways Telemedicine Changes The Healthcare Landscape, And What It Means For You

From:  Jeff Boss of FORBES


It’s no secret that the healthcare space is broken. A 2013 study conducted by the Journal of Patient Safety estimates that between 210,000 and 440,000 patients die in the US each year from accidental practice. To put this into perspective, an estimated 600,000 Americans die from heart disease each year and another 565,000 from cancer (source:, which puts healthcare incompetence as the third leading cause of death in the United States.

The pool of entrepreneurs in the race to offer mobile health consulting is growing larger by the day. With telemedicine, users have the power of accessibility in their hands with apps such as TouchCare and iBluebutton (see below). While the concept of telemedicine isn’t anything new, having the accessibility to one’s doctor is. Here are seven ways telemedicine changes the healthcare landscape—for the better:

1. Stronger relationships. Relationships are everything. If there was ever a person not to make angry, it’s your doctor. More important, your relationship with your doctor is everything, which is why mobile healthcare is so ideal. It offers the luxuries of personalization and convenience without exposing yourself or your child to the 15 other sickly patients normally waiting in your doctor’s office.

2. Convenience. TouchCare takes mobile healthcare to the next level as it creates an entirely new user experience for the customer. Rather than having to trek into the doctor’s office for a consult, you can now do so from the comfort of your own smartphone for follow up visits, after hours calls, or while traveling. Additionally, parents gain a stronger piece of mind because they can immediately reach their doctor for relatively benign symptoms such as a cough or runny nose.

3. Reduced complexity. Complexity is defined by the speed at which industries change and the interdependence of relationships therein. Telemedicine reduces both.

4. Greater awareness. iBlueButton is perhaps the most comprehensive app for telemedicine as it allows users (currently only for active duty military and veterans) to carry their own medical records  with them in their smartphone. For physicians, pop-up windows alert the provider of possible medication side effects for greater drug reconciliation.

5. Shared purpose. The focus of healthcare today appears to be more towards earning a profit rather than serving its purpose of patient care. The purpose of an organization is (ideally) to serve as a value differentiator to its customers because of what they (the company) stand for. Whatever a company’s flavor, its purpose is defined by a certifiable element that distinguishes it from all else, and that element is what attains and retains customers and fulfills a societal need. Bettina Experton, MD, MPH, and President & CEO of Humetrix, which is the company behind iBluebutton, believes that “collaborating for a higher purpose is a key corporate value… We work to empower patients and make them more informed healthcare consumers, and we think about ways to make life easier for parents, caregivers and families in an increasingly complex healthcare environment.” (source:

6. Improved efficiency. Smaller practices get bought out by larger organizations, which means new regulations and more bureaucracy are added into their daily routine. Nancy Zimmerman, head of Marketing for TouchCare, cited one practice in North Carolina who was recently bought out by a larger company who needed to scale back from seeing their normal 60 patients per day to 20 due to the added bureaucracy. Telemedicine eliminates phone consults and the addiction to answering emails.

7. Enhanced flexibility for physician. The immediacy of telemedicine provides direct access to the customer. iBlueButton users can directly share critical parts of their medical record with their doctor via secure messaging.

The changing landscape of healthcare offered through smartphone apps allows doctors to build stronger relationships with their patients rather than be just another MD—critical to the “patient” component of “patient care.”

–follow Jeff on Twitter

–Jeff’s upcoming book “Navigating Chaos: How to Find Certainty in Uncertain Situations” will be out in 2015. Read about it here.



Posted by: C3O Telemedicine News

Posted on: August 23rd, 2014

Posted in:

TelePharm gets $2.5M to help pharmacists be in two places at once

By: Jonah Comstock | Aug 12, 2014

from MobiHealth News

Iowa-based TelePharm has raised $2.5 millionfrom venture capitalist John Pappajohn and Bruce Rastetter, president of the Iowa state Board of Regents. The company, which is also a member of the Rock Health accelerator, will use the funds to scale its business, which connects pharmacists to one another and to patients via cloud-based mobile apps.

“I think the pharmacists’ position is changing,” TelePharm CEO Roby Miller told MobiHealthNews. “Instead of just counting pills and dispensing drugs, they are repositioning themselves to become more of a provider of healthcare and I think we’re trying to help them and enable them to become healthcare professionals.”

TelePharm has several different businesses that help pharmacists spread their expertise across multiple pharmacies. This allows local chains with spaced out rural pharmacies to reduce their overhead significantly. One business, TeleCheck, allows for remote verification of medications, one of the most important and time-consuming jobs pharmacists do.

“What a pharmacist does is, they have two different responsibilities: verifying it’s the right drug for that patient and basically making sure the patient will be safe with that drug, and making sure what the technician dispensed was the right drug,” Miller said. “What TeleCheck does, is it takes that workflow and puts it in the cloud. So a pharmacist has an image of the drug they’re dispensing, the label on the bottle, and the [prescription] as well. So they can compare those images and make sure the drug is the right prescription for that patient.”

The other service, which actually allows pharmacists to virtually interact with the patient directly, is called TeleCounsel. It’s used by hospitals with a pharmacist on staff to provide discharge counseling for patients leaving the hospital. Talking with a pharmacist before leaving the hospital leads to better adherence, Miller said, but is again often difficult to facilitate because it requires one pharmacist to be in so many different places in a large hospital or hospital system. With TeleCounsel, a pharmacist can talk to many different patients and even counsel patients after they go home.

This is the first round of funding for the company, which was founded in August 2012. TelePharm’s software is currently in eight small, regional pharmacy chains in three states: Iowa, Illinois, and Texas.

“We’re trying to prove that you don’t have to be on the East or West coast to make a company successful,” he said. “You can do it in a smaller midwestern setting.”

In an era of large chain pharmacies like Walgreens and CVS, which use mobile and web to add to the convenience of their many locations, it can be challenging for small local pharmacies to stay relevant. McKesson’s Health Mart franchise service, which went mobile last fall, is another effort to help those small chains keep pace with new technology.


Posted by: C3O Telemedicine News

Posted on: August 16th, 2014

Posted in:

ATA Applauds Congressional Push for Federal Telemedicine Improvements

According to Jon Linkous, CEO of the ATA “On Thursday, Sens. Cochran and Wicker, both Mississippi Republicans, introduced the Telehealth Enhancement Act as S. 2662, which is a companion bill to a House version, H.R. 3306, introduced by Rep. Gregg Harper (R-MS). S. 2662 includes several provisions that may be budget savers, building on recent payment innovations such as accountable care organizations, and other incremental budget-sensitive proposals. H.R. 3306 already has 20 bipartisan co-sponsors. These bills are instrumental in demonstrating widespread congressional support and in prompting the Congressional Budget Office to provide a budget estimate.”IPRqUxyy_normal


Posted by: C3O Telemedicine News

Posted on: July 29th, 2014

Posted in: