The goal of this report is to extend our original evidence report on the efficacy
of telemedicine by extending the assessment to the pediatrics and obstetrics
populations along with those receiving home telemedicine where the health care
provider was involved in an indirect manner.As with the initial report, which
covered telemedicine for the Medicare population, we assessed telemedicine
services that substitute for face-to-face medical diagnosis and treatment and
focused on three distinct telemedicine study areas -- store-and-forward,
self-monitoring/testing, and clinician-interactive services.
We conducted a search in the peer-reviewed literature for studies assessing the
efficacy and cost of telemedicine in the study areas and designated populations.
The search focused on peer-reviewed articles in the MEDLINE, CINAHL, and
HealthSTAR databases. We also identified relevant articles through hand
searching and reference lists in key papers.
The inclusion criteria were that the study addressed one of the designated
patient populations, was relevant to at least one of the three study areas,
addressed at least one key question in the analytic framework for that study
area, and contained reported results. We excluded articles that assessed
clinical services that did not historically require face-to-face encounters
(e.g., radiology or pathology diagnosis).
We identified a total of 28 studies that met inclusion criteria. In the new
clinical areas, we found few studies in store-and-forward telemedicine. There is
some evidence that diagnosis and clinical management decisions are improved by
store-and-forward telemedicine in the areas of pediatric dental screening,
pediatric ophthalmology, and neonatalogy. In self-monitoring/testing
telemedicine for the areas of pediatrics and obstetrics there is evidence that
access to care can be improved when patients and families have the opportunity
to receive telehealth care at home rather than in-person care in a clinic or
hospital. In the study area of clinician-indirect home telemedicine, there is
evidence that clinical outcomes are improved for patients with Human
Immunodeficiency Virus (HIV) infection and Alzheimer Disease.
There is some evidence that this form of telemedicine provides comparable health
outcomes relative to face-to-face care, but the study sample sizes were usually
small, as were the treatment effects. There is also some evidence for the
efficacy of clinician-interactive telemedicine, but the studies do not clearly
define which technologies provide benefit or cost-efficiency. Some promising
areas for diagnosis included emergency medicine, psychiatry, and cardiology.
Most of the studies measuring access to care provide evidence that it is
improved. Clinician-interactive telemedicine was the only area for which any
cost studies were found. The three cost studies did not adequately demonstrate
that telemedicine reduces costs of care (except when comparing only selected
costs). No study addressed cost-effectiveness.
Our conclusions echo the original report: Existing telemedicine programs
demonstrate that the technology can be made operational, but most of the studies
assessing the efficacy or cost are insufficient to permit definitive statements
about the evidence supporting (or not supporting) the benefits of telemedicine.
Future studies should focus on the use of telemedicine in conditions where
burden of illness and/or barriers to access for care are significant. Use of
recent innovations in the design of randomized controlled trials for emerging
technologies would lead to higher quality studies. Journals publishing
telemedicine evaluation studies must set high standards for methodologic quality
so that evidence reports need not rely on studies with marginal