1.  Assessing telemedicine: a systematic review of the literature

Author(s): Roine R, Ohinmaa A, Hailey D

Source: CMAJ 2001 Sep 18;165(6):765-71.

Summary: BACKGROUND: To clarify the current status of telemedicine, we carried out a systematic review of the literature. We identified controlled assessment studies of telemedicine that reported patient outcomes, administrative changes or economic assessments and assessed the quality of that literature. METHODS: We carried out a systematic electronic search for articles published from 1966 to early 2000 using the MEDLINE (1966-April 2000), HEALTHSTAR (1975-January 2000), EMBASE (1988-February 2000) and CINALH (1982-January 2000) databases. In addition, the HSTAT database (Health Services/Technology Assessment Text, US National Library of Medicine), the Database of Abstracts of Reviews of Effectiveness (DARE, NHS Centre for Reviews and Dissemination, United Kingdom), the NHS Economic Evaluation Database and the Cochrane Controlled Trials Register were searched. We consulted experts in the field and did a manual search of the reference lists of review articles. RESULTS: A total of 1124 studies were identified. Based on a review of the abstracts, 133 full-text articles were obtained for closer inspection. Of these, 50 were deemed to represent assessment studies fulfilling the inclusion criteria of the review. Thirty-four of the articles assessed at least some clinical outcomes; the remaining 16 were mainly economic analyses. Most of the available literature referred only to pilot projects and short-term outcomes, and most of the studies were of low quality. Relatively convincing evidence of effectiveness was found only for teleradiology, teleneurosurgery, telepsychiatry, transmission of echocardiographic images, and the use of electronic referrals enabling e-mail consultations and video conferencing between primary and secondary health care providers. Economic analyses suggested that teleradiology, especially transmission of CT images, can be cost-saving. INTERPRETATION: Evidence regarding the effectiveness or cost-effectiveness of telemedicine is still limited. Based on current scientific evidence, only a few telemedicine applications can be recommended for broader use.

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2.  Determinants of successful telemedicine implementations: a literature study

Author(s): Broens TH, Huis in't Veld RM, Vollenbroek-Hutten MM, Hermens HJ, van Halteren AT, Nieuwenhuis LJ

Source: J Telemed Telecare 2007 (NULL);13(6):303-9.

Summary: 

Telemedicine implementations often remain in the pilot phase and do not succeed in scaling-up to robust products that are used in daily practice. We conducted a qualitative literature review of 45 conference papers describing telemedicine interventions in order to identify determinants that had influenced their implementation. The identified determinants, which would influence the future implementation of telemedicine interventions, can be classified into five major categories: (1) Technology, (2) Acceptance, (3) Financing, (4) Organization and (5) Policy and Legislation. Each category contains determinants that are relevant to different stakeholders in different domains. We propose a layered implementation model in which the primary focus on individual determinants changes throughout the development life cycle of the telemedicine implementation. For success, a visionary approach is required from the multidisciplinary stakeholders, which goes beyond tackling specific issues in a particular development phase. Thus the right philosophy is: 'start small, think big'.

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3.  Evaluating telemedicine: lessons and challenges

Author(s): Brear M

Source: HIM J 2006 (NULL);35(2):23-31.

Summary: Telemedicine applications have been rapidly implemented since the early 1990s and are now in use in a wide range of healthcare settings. There is, however, limited evidence of clinical benefits resulting from their use. this paper describes the design and implementation of a multi-method evaluation of an emergency telemedicine applications clinical impact. In particular, the challenges faced and lessons learnt regarding the development of a suitable methodology and collection of health information from a variety of sources are discussed. In order to understand the applications clinical impact it was necessary to use different types of data from multiple sources, and to interpret the results from each enquiry in relation to results from the others.

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4.  The relationship of a diabetes telehealth eye care program to standard eye care and change in diabetes health outcomes

Author(s): Fonda SJ, Bursell SE, Lewis DG, Garren J, Hock K, Cavallerano J

Source: Telemed J E Health 2007 Dec;13(6):635-44.

Summary: 

Several studies suggest that telehealth eye care programs that combine retinal imaging, education, and some care management can improve patient adherence to annual, comprehensive eye examinations and follow-up treatments. Little is known, however, about whether such programs relate to other, more distal outcomes that affect diabetic eyedisease, such as blood glucose control. This paper assesses the relationship of participation in a diabetes telehealth eye care program with standard, face-to-face eye care as well as improvements in other diabetes-related health outcomes. We conducted a retrospective study using data from electronic medical records of Joslin Diabetes Center(n=13,752). The data span 2 years: baseline and follow-up. Subjects' eye care groups were no eye care, eye care outside of the clinic, standard eye care at the clinic, or participation in the Joslin Vision Network telehealth eye care program. We analyzed the relationship of participation in the telehealth eye care program at baseline tofollow-up eye care groups and changes in hemoglobin A1c, low density lipoprotein levels, and systolic blood pressure. The results show that participation in the telehealth eye care program was significantly correlated with whether subjects later obtained standard eye care, improvement in hemoglobin A1c, and improvement in low densitylipoprotein. Thus, telehealth eye care programs that incorporate evaluation, education, and care planning are related to use of recommended eye care and improvements in certain diabetes-related health outcomes. Such programs can address the many aspects of care necessary to reduce risk of vision loss due to diabetic retinopathy andother diabetes-related complications. Future research might test hypotheses suggested by sociological and psychological theories regarding causation between participation in a telehealth eye care program and other diabetes care.

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5.  Videoconferencing: practical advice on implementation

Author(s): Sen Gupta TK, Wallace DA, Clark SL, Bannan G

Source: Aust J Rural Health 1998 Feb;6(1):2-4.

Summary: Videoconferencing provides a useful tool for improving information flow, with clinical, educational and administrative uses being particularly relevant to rural and remote Australia. This paper describes the range of possible uses for computer-based videoconferencing and describes the authors' experience in delivering rural medical education in North Queensland via videoconference. Principles that ensure successful videoconferencing are outlined and are applicable to a variety of formats and uses. They include the need to keep it simple, the importance of thorough preparation, and ensuring that education drives technology, rather than the converse.