Telemedicine
Community in Action
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 modalities1. 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.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Increased access to care
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Improved mental health
Reduced mortality
Increased medication adherence
Reduced vehicle miles traveled
Reduced emissions
What does the research say about effectiveness? This strategy is rated scientifically supported.
There is strong evidence that telemedicine increases access to care2, 3, 4, 5, 6, 7, 8, 9, especially for individuals with chronic conditions4, 6 and those in rural and other traditionally underserved areas10, 11, 12. Additional evidence is needed to determine the characteristics of the most successful telemedicine practices6, 8, 13, 14, 15 and better understand use in active treatments such as telestroke, teleoncology, and teledialysis16.
Telemedicine can improve health outcomes for long-term chronic conditions such as asthma, diabetes, heart failure, COPD, and hypertension3, 4, 7, 13, 17, 18, 19, 20, 21, as well as mental illness8, 12. Telemedicine has been shown to decrease mortality for patients with a history of chronic heart failure5 as effectively as usual care, and can improve blood glucose control13. Tele-monitoring appears to be as effective as other methods of monitoring blood glucose during pregnancy for women with pre-existing diabetes22 and may reduce unscheduled visits among women with gestational diabetes23. It is at least as effective at treating mental health13 and substance abuse problems as traditional methods9, 13.
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 outcomes24. Telemedicine appears to be an effective way to treat children and adolescents25, and monitor the health of older adults26. Telemedicine may reduce physician-related medication errors among seriously ill or injured children in rural emergency departments27, and can increase medication adherence when used in home health care virtual visits28.
Telerehabilitation services may improve motor function following total knee replacement29 and reduce short-term disability and symptoms for patients with multiple sclerosis30. Telerehabilitation also appears to produce similar outcomes to center-based cardiac rehabilitation for low to moderate risk coronary artery disease patients31. Teleglaucoma screening detects more cases of glaucoma than in-person screening in remote and underserved communities32, and, overall, telemedicine appears to increase access to care for speech, language, and hearing services33.
Telemedicine appears to be a cost effective way to deliver care34, 35. Once the technology is in place, providing care through telemedicine may be less costly than standard care36. However, high initial implementation costs and limited payment policies can be barriers to establishing telemedicine programs3, 36.
Telemedicine has the potential to reduce the carbon footprint of the health care industry, primarily by reducing vehicle miles traveled (VMT) and greenhouse gas emissions from patients driving to appointments. Telemedicine does generate some carbon emissions and those amounts vary, for example, with the length of the appointment, type of teleconferencing platform used, energy used to support the virtual connection, and different broadband capacities. In general, telemedicine appointments that replace a car trip of a few kilometers or more reduce carbon emissions37, 38.
How could this strategy impact health disparities? This strategy is rated likely to decrease disparities.
Implementation Examples
As of January 2021, all 50 states and Washington, D.C. provide Medicaid reimbursement for at least some telehealth services, and 43 states and Washington, D.C. have telehealth private payer laws39.
A number of telemedicine and telehealth programs exist in the United States40. The Missouri Telehealth Network41, for example, is aimed at enhancing access to care in underserved areas of Missouri. The Children’s National Medical Center in Washington, D.C. has a telemedicine program that serves community hospitals, suburban health centers, inner-city health clinics, national hospitals, and international partners42.
As of December 2014, 41 states and Washington, D.C. have a law defining telemedicine practices; 24 states and Washington, D.C. have laws allowing primary care providers to deliver care via telehealth43.
Implementation Resources
LawAtlas-Telehealth - LawAtlas. Telehealth and primary care provider laws map.
ATA - American Telemedicine Association (ATA).
HRSA-Telehealth - Health Resources and Services Administration (HRSA), Office for the Advancement of Telehealth. Telehealth active programs.
Footnotes
* Journal subscription may be required for access.
1 ATA - American Telemedicine Association (ATA).
2 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.
3 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.
4 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.
5 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.
6 McLean 2011 - McLean S, Protti D, Sheikh A. Telehealthcare for long term conditions. BMJ. 2011;342:d120.
7 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.
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.
9 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.
10 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.
11 Bashshur 2009 - Bashshur RL, Shannon GW. National telemedicine initiatives: Essential to healthcare reform. Telemedicine Journal and e-Health. 2009;15(6):600-10.
12 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.
13 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.
14 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.
15 Garcia-Lizana 2010 - García-Lizana F, Muñoz-Mayorga I. Telemedicine for depression: A systematic review. Perspectives in Psychiatric Care. 2010;46(2):119-26.
16 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.
17 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.
18 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.
19 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.
20 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.
21 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.
22 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.
23 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.
24 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.
25 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.
26 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.
27 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.
28 Husebo 2014 - Husebø AML, Storm M. Virtual visits in home health care for older adults. The Scientific World Journal. 2014;2014:689873.
29 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.
30 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.
31 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.
32 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.
33 Molini-Avejonas 2015 - Molini-Avejonas DR, Rondon-Melo S, de La Higuera Amato CA, 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.
34 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.
35 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.
36 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.
37 Dacones 2021 - Dacones I, Cave C, Furie GL, Ogden CA, Slutzman JE. Patient transport greenhouse gas emissions from outpatient care at an integrated health care system in the Northwestern United States, 2015–2020. The Journal of Climate Change and Health. 2021;3.
38 Holmner 2014 - Holmner Å, Ebi KL, Lazuardi L, Nilsson M. Carbon footprint of telemedicine solutions - Unexplored opportunity for reducing carbon emissions in the health sector. PLoS ONE. 2014;9(9).
39 NCSL-Telehealth - National Conference of State Legislatures (NCSL). State telehealth policies.
40 HRSA-Telehealth - Health Resources and Services Administration (HRSA), Office for the Advancement of Telehealth. Telehealth active programs.
41 MTN - Missouri Telehealth Network (MTN). Improving health with telecommunications technology.
42 CNHS-Telemedicine - Children’s National Health System (CNHS). Telemedicine.
43 LawAtlas-Telehealth - LawAtlas. Telehealth and primary care provider laws map.
Related What Works for Health Strategies
To see citations and implementation resources for this strategy, visit:
countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/telemedicine
To see all strategies:
countyhealthrankings.org/whatworks