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Telemedicine

Evidence Rating

Scientifically Supported

Health Factors

Telemedicine, sometimes called telehealth, uses telecommunications technology to deliver consultative, diagnostic, and health care treatment services via videoconferencing, transmission of still images, remote monitoring of vital signs, or other modalities (ATA). Telemedicine can supplement health care services for patients who would benefit from frequent monitoring or provide services to individuals in areas with limited access to care.

Expected Beneficial Outcomes

  • Increased access to care

  • Improved health outcomes

Evidence of Effectiveness

There is strong evidence that telemedicine increases access to care (Franek 2012, Brown 2007, , Wootton 2012, Clark 2007, Bajpai 2012, , , , IHE-Ohinmaa 2010) especially for individuals with chronic conditions (, Wootton 2012, ) and those in rural and other traditionally underserved areas (Kehle 2011, Bajpai 2012, Bashshur 2009, Penate 2012). Additional evidence is needed to determine the characteristics of the most successful telemedicine practices (, , , , ).

Telemedicine can improve health outcomes for long-term chronic conditions such as asthma, diabetes, heart failure, COPD, and hypertension (Brown 2007, , Wootton 2012, ) as well as mental illness (, Penate 2012). Telemedicine has been shown to decrease mortality for patients with a history of chronic heart failure (Clark 2007, ) and is at least as effective at treating alcohol and smoking addictions as traditional methods (IHE-Ohinmaa 2010). 

Telemedicine may also reduce risk factors for cardiovascular disease (). Telephone interventions appear to increase medication adherence in individuals with HIV infection and reduce risky sexual behavior, but further research is needed to determine effects on health outcomes (Cochrane-Gentry 2013).Telemedicine appears to be an effective way to treat children and adolescents (dos Santos 2014), and monitor the health of older adults (). 

Telemedicine appears to be a cost effective way to deliver care (), and once the technology is in place, providing care through telemedicine may be less costly than standard care (Henderson 2013). However, high initial implementation costs and limited payment policies can be barriers to establishing telemedicine programs (Henderson 2013, Brown 2007).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

As of 2014, 49 states and the District of Columbia provide Medicaid reimbursement for telehealth services, and 19 states and the District of Columbia require private insurance plans to cover telehealth (NCSL-Telehealth). 

A number of telemedicine and telehealth programs exist in the United States (HRSA-Telehealth networks). The Missouri Telehealth Network (MTN), for example, is aimed at enhancing access to care in underserved areas of Missouri. The Children’s National Medical Center in Washington DC has a telemedicine program that serves community hospitals, suburban health centers, inner-city health clinics, national hospitals, and international partners (CNMC-Telemedicine).

Implementation Resources

ATA - American Telemedicine Association (ATA).

HRSA-Telehealth - Health Resources and Services Administration (HRSA). Telehealth.

COCIR-Telemedicine 2011 - COCIR. COCIR telemedicine toolkit: Supporting effective deployment of telehealth and mobile health. Brussels, BE: European Coordination Committee of the Radiological, Electromedical and Healthcare IT Industry (COCIR); 2011.

SNI-Telehealth 2009 - California Health Care Safety Net Institute (SNI). Telemedicine resource guide. Oakland: California Health Care Safety Net Institute (SNI); 2009.

CTA-ADOPT Toolkit - Center for Technology and Aging. ADOPT toolkit: Helping organizations design and implement connected health technology.

Citations - Evidence

* Journal subscription may be required for access.

Clark 2007 - Clark RA, Inglis SC, McAlister FA, Cleland JG, Stewart S. Telemonitoring or structured telephone support programmes for patients with chronic heart failure: Systematic review and meta-analysis. BMJ. 2007;334(7600):942.

Kehle 2011 - Kehle SM, Greer N, Rutks I, Wilt T. Interventions to improve veterans’ access to care: A systematic review of the literature. Journal of General Internal Medicine. 2011;26(Suppl 2):689-96.

Bashshur 2009 - Bashshur RL, Shannon GW. National telemedicine initiatives: Essential to healthcare reform. Telemedicine Journal and e-Health. 2009;15(6):600-10.

Bajpai 2012 - Bajpai M. Telemedicine: A review. WebmedCentral PUBLIC HEALTH. 2012;3(2):WMC002847.

Cochrane-Currell 2000* - Currell R, Urquhart C, Wainwright P, Lewis R. Telemedicine versus face to face patient care: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews. 2000;(2):CD002098.

McLean 2011* - McLean S, Protti D, Sheikh A. Telehealthcare for long term conditions. BMJ. 2011;342:d120.

Eland-de Kok 2011* - Eland-de Kok P, van Os-Medendorp H, Vergouwe-Meijer A, Bruijnzeel-Koomen C, Ros W. A systematic review of the effects of e-health on chronically ill patients. Journal of Clinical Nursing. 2011;20(21/22):2997-3010.

Garcia-Lizana 2010* - García-Lizana F, Muñoz-Mayorga I. Telemedicine for depression: A systematic review. Perspectives in Psychiatric Care. 2010;46(2):119-26.

Farmer 2005* - Farmer A, Gibson OJ, Tarassenko L, Neil A. A systematic review of telemedicine interventions to support blood glucose self-monitoring in diabetes. Diabetic Medicine. 2005;22(10):1372-8.

Hailey 2008* - Hailey D, Roine R, Ohinmaa A. The effectiveness of telemental health applications: A review. Canadian Journal of Psychiatry. 2008;53(11):769-78.

IHE-Ohinmaa 2010 - Ohinmaa A, Chatterley P, Nguyen T, Jacobs P. Telehealth in substance abuse and addiction: Review of the literature on smoking, alcohol, drug abuse and gambling. Alberta, CAN: Institute of Health Economics (IHE); 2010.

Franek 2012 - Franek J. Home telehealth for patients with chronic obstructive pulmonary disease (COPD): An evidence-based analysis. Ontario Health Technology Assessment Series. 2012;12(11):1–58.

Brown 2007 - Brown LL, Lustria MLA, Rankins J. A review of web-assisted interventions for diabetes management: Maximizing the potential for improving health outcomes. Journal of Diabetes Science and Technology. 2007;1(6):892–902.

Penate 2012 - Peñate W. About the effectiveness of telehealth procedures in psychological treatments. International Journal of Clinical and Health Psychology. 2012;12(3):475–87.

Car 2012* - Car J, Huckvale K, Hermens H. Telehealth for long term conditions. BMJ. 2012;344:e4201.

Henderson 2013 - Henderson C, Knapp M, Fernandez JL, et al. Cost effectiveness of telehealth for patients with long term conditions (whole systems demonstrator telehealth questionnaire study): Nested economic evaluation in a pragmatic, cluster randomised controlled trial. BMJ. 2013;346:f1035.

Wootton 2012 - Wootton R. Twenty years of telemedicine in chronic disease management - An evidence synthesis. Journal of Telemedicine and Telecare. 2012;18(4):211–20.

dos Santos 2014 - dos Santos MTN, Moura SCDO, Gomes LMX, et al. Telehealth application on the rehabilitation of children and adolescents. Revista paulista de pediatria: orgão oficial da Sociedade de Pediatria de São Paulo. 2014;32(1):136–43.

van den Berg 2012* - van den Berg N, Schumann M, Kraft K, Hoffmann W. Telemedicine and telecare for older patients: A systematic review. Maturitas. 2012;73(2):94–114.

Merriel 2014* - Merriel SWD, Andrews V, Salisbury C. Telehealth interventions for primary prevention of cardiovascular disease: A systematic review and meta-analysis. Preventive Medicine. 2014;64:88-95.

Cochrane-Gentry 2013 - Gentry S, van-Velthoven MH, Tudor CL, Car J. Telephone delivered interventions for reducing morbidity and mortality in people with HIV infection. Cochrane Database of Systematic Reviews. 2013;(5):CD009189.

Jennett 2003* - Jennett PA, Affleck Hall L, Hailey D, et al. The socio-economic impact of telehealth. Journal of Telemedicine and Telecare. 2003;9(6):311-320.

Citations - Implementation Examples

* Journal subscription may be required for access.

CNMC-Telemedicine - Children’s National Health System. Telemedicine.

HRSA-Telehealth networks - Health Resources and Services Administration (HRSA). Telehealth networks.

MTN - Missouri Telehealth Network (MTN). Improving health with telecommunications technology.

NCSL-Telehealth - National Conference of State Legislatures (NCSL). State coverage for telehealth services.

Date Last Updated

Sep 2, 2014
  • Scientifically Supported: Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
  • Some Evidence: Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.
  • Expert Opinion: Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.
  • Insufficient Evidence: Strategies with this rating have limited research documenting effects. These strategies need further research, often with stronger designs, to confirm effects.
  • Mixed Evidence: Strategies with this rating have been tested more than once and results are inconsistent or trend negative; further research is needed to confirm effects.
  • Evidence of Ineffectiveness: Strategies with this rating are not good investments. These strategies have been tested in many robust studies with consistently negative and sometimes harmful results.