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Telemedicine

Telemedicine, sometimes called telehealth, uses telecommunications technology to deliver consultative, diagnostic, and health care treatment services. Services can encompass primary and specialty care, referrals, and remote monitoring of vital signs, and may be provided via videoconference, email, smartphones, wireless tools, 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 (Rated)

  • Increased access to care

Other Potential Beneficial Outcomes

  • Improved mental health

  • Reduced mortality

  • Increased medication adherence

Evidence of Effectiveness

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

Telemedicine can improve health outcomes for long-term chronic conditions such as asthma, diabetes, heart failure, COPD, and hypertension (, , Huang 2015, , Greenwood 2014, , 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) as effectively as usual care, and can improve blood glucose control (). Tele-monitoring appears to be as effective as other methods of monitoring blood glucose during pregnancy for women with pre-existing diabetes () and may reduce unscheduled visits among women with gestational diabetes (). It is at least as effective at treating mental health () and substance abuse problems as traditional methods (, IHE-Ohinmaa 2010).

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 may reduce physician-related medication errors among seriously ill or injured children in rural emergency departments (Dharmar 2013), and can increase medication adherence when used in home health care virtual visits ().

Telerehabilitation services may improve motor function following total knee replacement () and reduce short-term disability and symptoms for patients with multiple sclerosis (). Telerehabilitation also appears to produce similar outcomes to center-based cardiac rehabilitation for low to moderate risk coronary artery disease patients (). Teleglaucoma screening detects more cases of glaucoma than in-person screening in remote and underserved communities (), and, overall, telemedicine appears to increase access to care for speech, language, and hearing services ().

Telemedicine appears to be a cost effective way to deliver care (, ). 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 December 2015, 48 states and the District of Columbia provide Medicaid reimbursement for at least some telehealth services, and 32 states and the District of Columbia have telehealth private payer laws (NCSL-Telehealth).

A number of telemedicine and telehealth programs exist in the United States (HRSA-Telehealth programs). 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 (CNHS-Telemedicine).

As of December 2014, 41 states and Washington, DC have a law defining telemedicine practices; 24 states and Washington, DC have laws allowing primary care providers to deliver care via telehealth (LawAtlas-Telehealth).

Implementation Resources

ATA - American Telemedicine Association (ATA).

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

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

LawAtlas-Telehealth - LawAtlas. Telehealth and primary care provider laws map.

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.

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.

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.

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.

Agostini 2015* - Agostini M, Moja L, Banzi R, et al. Telerehabilitation and recovery of motor function: A systematic review and meta-analysis. Journal of Telemedicine and Telecare. 2015;21(4):202–213.

Cochrane-Flodgren 2015* - Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: Effects on professional practice and health care outcomes (Review). Cochrane Database of Systematic Reviews. 2015;(9):CD002098.

Cochrane-Khan 2015* - Khan F, Amatya B, Kesselring J, Galea M. Telerehabilitation for persons with multiple sclerosis (Review). Cochrane Database of Systematic Reviews. 2015;(4):CD010508.

Cochrane-Moy 2014* - Moy FM, Ray A, Buckley BS. Techniques of monitoring blood glucose during pregnancy for women with pre-existing diabetes (Review). Cochrane Database of Systematic Reviews. 2014;(4):CD009613.

Cruz 2014* - Cruz J, Brooks D, Marques A. Home telemonitoring effectiveness in COPD: A systematic review. International Journal of Clinical Practice. 2014;68(3):369–378.

Dharmar 2013 - Dharmar M, Kuppermann N, Romano PS, et al. Telemedicine consultations and medication errors in rural emergency departments. Pediatrics. 2013;132(6):1090-1097.

Cochrane-Kew 2016* - Kew KM, Cates CJ. Remote versus face-to-face check-ups for asthma (Review). Cochrane Database of Systematic Reviews. 2016;(4):CD011715.

Greenwood 2014 - Greenwood DA, Young HM, Quinn CC. Telehealth remote monitoring systematic review: Structured self-monitoring of blood glucose and impact on A1C. Journal of Diabetes Science and Technology. 2014;8(2):378–389.

Huang 2015 - Huang Z, Tao H, Meng Q, Jing L. Effects of telecare intervention on glycemic control in type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. European Journal of Endocrinology. 2015;172(3):R93-R101.

Huang 2015a* - Huang K, Liu W, He D, et al. Telehealth interventions versus center-based cardiac rehabilitation of coronary artery disease: A systematic review and meta-analysis. European Journal of Preventive Cardiology. 2015;22(8):959-971.

Husebo 2014* - Husebø AML, Storm M. Virtual visits in home health care for older adults. The Scientific World Journal. 2014;2014:689873.

Jhaveri 2015* - Jhaveri D, Larkins S, Sabesan S. Telestroke, tele-oncology and teledialysis: A systematic review to analyse the outcomes of active therapies delivered with telemedicine support. Journal of Telemedicine and Telecare. 2015;21(4):181–188.

Molini-Avejonas 2015* - Molini-Avejonas DR, Rondon-Melo S, Albuquerque de La Higuera Amato C, Samelli AG. A systematic review of the use of telehealth in speech, language and hearing sciences. Journal of Telemedicine and Telecare. 2015;21(7):367–376.

Rasekaba 2015* - Rasekaba TM, Furler J, Blackberry I, et al. Telemedicine interventions for gestational diabetes mellitus: A systematic review and meta-analysis. Diabetes Research and Clinical Practice. 2015;110(1):1–9.

Thomas 2014b* - Thomas SM, Jeyaraman M, Hodge WG, et al. The effectiveness of teleglaucoma versus in-patient examination for glaucoma screening: A systematic review and meta-analysis. PLoS ONE. 2014;9(12):e113779.

Yang 2015* - Yang NH, Dharmar M, Yoo BK, et al. Economic evaluation of pediatric telemedicine consultations to rural emergency departments. Medical Decision Making. 2015;35(6):773–783.

Zhai 2014* - Zhai, Y, Zhu W, Cai Y, Sun D, Zhao J. Clinical- and cost-effectiveness of telemedicine in type 2 diabetes mellitus: A systematic review and meta-analysis. Medicine (Baltimore). 2014;93(28):e312.

Citations - Implementation Examples

* Journal subscription may be required for access.

CNHS-Telemedicine - Children’s National Health System (CNHS). Telemedicine.

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

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

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

LawAtlas-Telehealth - LawAtlas. Telehealth and primary care provider laws map.

Date Last Updated

Jun 6, 2016