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Pediatrics Jul 2015Telemedicine is a technological tool that is improving the health of children around the world. This report chronicles the use of telemedicine by pediatricians and... (Review)
Review
Telemedicine is a technological tool that is improving the health of children around the world. This report chronicles the use of telemedicine by pediatricians and pediatric medical and surgical specialists to deliver inpatient and outpatient care, educate physicians and patients, and conduct medical research. It also describes the importance of telemedicine in responding to emergencies and disasters and providing access to pediatric care to remote and underserved populations. Barriers to telemedicine expansion are explained, such as legal issues, inadequate payment for services, technology costs and sustainability, and the lack of technology infrastructure on a national scale. Although certain challenges have constrained more widespread implementation, telemedicine's current use bears testimony to its effectiveness and potential. Telemedicine's widespread adoption will be influenced by the implementation of key provisions of the Patient Protection and Affordable Care Act, technological advances, and growing patient demand for virtual visits.
Topics: Child; Delivery of Health Care; Humans; Pediatrics; Telemedicine; United States
PubMed: 26122813
DOI: 10.1542/peds.2015-1517 -
Current Allergy and Asthma Reports Aug 2018Due to rapid advancements in quality of real-time, interactive, audio-visual, and digital technologies as well as impressive gains in internet speed and capacity,... (Review)
Review
PURPOSE OF REVIEW
Due to rapid advancements in quality of real-time, interactive, audio-visual, and digital technologies as well as impressive gains in internet speed and capacity, medicine delivered over distance is happening faster than many healthcare providers and leaders can grasp.
RECENT FINDINGS
Depending on which market report you ascribe to, industry projections for the global compounded annual growth rate of telemedicine are between 13 and 27%, with valuation growing to over 20 billion US dollars in the next several years. The Mayo Clinic has reworked its entire telemedicine interest to a model with centralized operations, one virtual technology platform, standardized training, and connectedness for all of its locations. The National Quality Forum spent 2016 and 2017 formulating 70 some pages of recommendations for expanded measures to valuate telemedicine over the foreseeable future. There are so many patient experience studies indicating high satisfaction with telemedicine, that professionals in the industry accept it as fact. Telemedicine is leaving novel to the past. This short, informative piece of writing includes expert opinion and research findings about what is telemedicine, why one should practice telemedicine, and how one should approach implementation; a primer from which to grow.
Topics: Humans; Insurance, Health; Legislation, Medical; Licensure, Medical; Telemedicine; Workforce
PubMed: 30145709
DOI: 10.1007/s11882-018-0808-4 -
International Journal of Medical... Nov 2010To conduct a review of reviews on the impacts and costs of telemedicine services. (Review)
Review
OBJECTIVES
To conduct a review of reviews on the impacts and costs of telemedicine services.
METHODS
A review of systematic reviews of telemedicine interventions was conducted. Interventions included all e-health interventions, information and communication technologies for communication in health care, Internet based interventions for diagnosis and treatments, and social care if important part of health care and in collaboration with health care for patients with chronic conditions were considered relevant. Each potentially relevant systematic review was assessed in full text by one member of an external expert team, using a revised check list from EPOC (Cochrane Effective Practice and Organisation of Care Group) to assess quality. Qualitative analysis of the included reviews was informed by principles of realist review.
RESULTS
In total 1593 titles/abstracts were identified. Following quality assessment, the review included 80 heterogeneous systematic reviews. Twenty-one reviews concluded that telemedicine is effective, 18 found that evidence is promising but incomplete and others that evidence is limited and inconsistent. Emerging themes are the particularly problematic nature of economic analyses of telemedicine, the benefits of telemedicine for patients, and telemedicine as complex and ongoing collaborative achievements in unpredictable processes.
CONCLUSIONS
The emergence of new topic areas in this dynamic field is notable and reviewers are starting to explore new questions beyond those of clinical and cost-effectiveness. Reviewers point to a continuing need for larger studies of telemedicine as controlled interventions, and more focus on patients' perspectives, economic analyses and on telemedicine innovations as complex processes and ongoing collaborative achievements. Formative assessments are emerging as an area of interest.
Topics: Cost-Benefit Analysis; Health Services Accessibility; Health Services Research; Humans; Outcome Assessment, Health Care; Policy Making; Rural Health Services; Telemedicine; United States
PubMed: 20884286
DOI: 10.1016/j.ijmedinf.2010.08.006 -
Journal of General Internal Medicine Oct 2017This article summarizes the report of the American Medical Association's (AMA) Council on Ethical and Judicial Affairs (CEJA) on ethical practice in telehealth and... (Review)
Review
This article summarizes the report of the American Medical Association's (AMA) Council on Ethical and Judicial Affairs (CEJA) on ethical practice in telehealth and telemedicine. Through its reports and recommendations, CEJA is responsible for maintaining and updating the AMA Code of Medical Ethics (Code). CEJA reports are developed through an iterative process of deliberation with input from multiple stakeholders; report recommendations, once adopted by the AMA House of Delegates, become ethics policy of the AMA and are issued as Opinions in the Code. To provide enduring guidance for the medical profession as a whole, CEJA strives to articulate expectations for conduct that are as independent of specific technologies or models of practice as possible. The present report, developed at the request of the House of Delegates, provides broad guidance for ethical conduct relating to key issues in telehealth/telemedicine. The report and recommendations were debated at meetings of the House in June and November 2015; recommendations were adopted in June 2016 and published as Opinion E-1.2.12, Ethical Practice in Telemedicine, in November 2016. A summary of the key points of the recommendations can be found in Appendix A (online), and the full text of the opinion can be found in Appendix B (online).
Topics: Continuity of Patient Care; Ethics, Medical; Humans; Telemedicine
PubMed: 28653233
DOI: 10.1007/s11606-017-4082-2 -
Applied Clinical Informatics Nov 2016Developing countries need telemedicine applications that help in many situations, when physicians are a small number with respect to the population, when specialized... (Review)
Review
BACKGROUND
Developing countries need telemedicine applications that help in many situations, when physicians are a small number with respect to the population, when specialized physicians are not available, when patients and physicians in rural villages need assistance in the delivery of health care. Moreover, the requirements of telemedicine applications for developing countries are somewhat more demanding than for developed countries. Indeed, further social, organizational, and technical aspects need to be considered for successful telemedicine applications in developing countries.
OBJECTIVE
We consider all the major projects in telemedicine, devoted to developing countries, as described by the proper scientific literature. On the basis of such literature, we want to define a specific taxonomy that allows a proper classification and a fast overview of telemedicine projects in developing countries. Moreover, by considering both the literature and some recent direct experiences, we want to complete such overview by discussing some design issues to be taken into consideration when developing telemedicine software systems.
METHODS
We considered and reviewed the major conferences and journals in depth, and looked for reports on the telemedicine projects.
RESULTS
We provide the reader with a survey of the main projects and systems, from which we derived a taxonomy of features of telemedicine systems for developing countries. We also propose and discuss some classification criteria for design issues, based on the lessons learned in this research area.
CONCLUSIONS
We highlight some challenges and recommendations to be considered when designing a telemedicine system for developing countries.
Topics: Developing Countries; Humans; Surveys and Questionnaires; Telemedicine
PubMed: 27803948
DOI: 10.4338/ACI-2016-06-R-0089 -
Journal of Innovation in Health... Mar 2018Although the formal evidence base is equivocal, practical experience suggests that implementations of technology that support telemedicine initiatives can result in...
BACKGROUND
Although the formal evidence base is equivocal, practical experience suggests that implementations of technology that support telemedicine initiatives can result in improved patient outcomes, better patient and carer experience and reduced expenditure.
OBJECTIVE
To answer the questions "Is an investment in telemedicine worth it?" and "How do I make a telemedicine implementation work?"
METHODS
Summary of systematic review evidence and an illustrative case study. Discussion of implications for industry and policy.
RESULTS
Realisation of telemedicine benefits is much less to do with the technology itself and much more around the context of the implementing organisation and its ability to implement.
CONCLUSION
We recommend that local organisations consider deployment of telemedicine initiatives but with a greater awareness of the growing body of implementation best practice. We also recommend, for the NHS, that the centre takes a greater role in the collation and dissemination of best practice to support successful implementations of telemedicine and other health informatics initiatives.
Topics: Evidence-Based Medicine; Health Plan Implementation; Humans; Medical Informatics; Organizational Case Studies; Review Literature as Topic; Telemedicine
PubMed: 29717950
DOI: 10.14236/jhi.v25i1.957 -
Soins; La Revue de Reference Infirmiere Nov 2016Developments in cyberhealth are now accessible to all patients and healthcare professionals. These tools enable expert advice to be provided remotely and ensure a... (Review)
Review
Developments in cyberhealth are now accessible to all patients and healthcare professionals. These tools enable expert advice to be provided remotely and ensure a continuity of care for all those who need it. Telecare is developing across the world, as are networks of nurses who practise it and researchers who analyse the results.
Topics: Global Health; History, 21st Century; Humans; Nurses; Nursing Care; Telemedicine
PubMed: 27894484
DOI: 10.1016/j.soin.2016.09.013 -
Telemedicine Journal and E-health : the... Feb 2015A systematic review of cost-utility and cost-effectiveness research works of telemedicine, electronic health (e-health), and mobile health (m-health) systems in the... (Review)
Review
OBJECTIVE
A systematic review of cost-utility and cost-effectiveness research works of telemedicine, electronic health (e-health), and mobile health (m-health) systems in the literature is presented.
MATERIALS AND METHODS
Academic databases and systems such as PubMed, Scopus, ISI Web of Science, and IEEE Xplore were searched, using different combinations of terms such as "cost-utility" OR "cost utility" AND "telemedicine," "cost-effectiveness" OR "cost effectiveness" AND "mobile health," etc. In the articles searched, there were no limitations in the publication date.
RESULTS
The search identified 35 relevant works. Many of the articles were reviews of different studies. Seventy-nine percent concerned the cost-effectiveness of telemedicine systems in different specialties such as teleophthalmology, telecardiology, teledermatology, etc. More articles were found between 2000 and 2013. Cost-utility studies were done only for telemedicine systems.
CONCLUSIONS
There are few cost-utility and cost-effectiveness studies for e-health and m-health systems in the literature. Some cost-effectiveness studies demonstrate that telemedicine can reduce the costs, but not all. Among the main limitations of the economic evaluations of telemedicine systems are the lack of randomized control trials, small sample sizes, and the absence of quality data and appropriate measures.
Topics: Cost-Benefit Analysis; Electronic Health Records; Humans; Telemedicine
PubMed: 25474190
DOI: 10.1089/tmj.2014.0053 -
International Journal of Technology... Dec 2023Telemedicine may improve healthcare access and efficiency if it demands less clinician time than usual care. We sought to describe the degree to which telemedicine... (Review)
Review
OBJECTIVES
Telemedicine may improve healthcare access and efficiency if it demands less clinician time than usual care. We sought to describe the degree to which telemedicine trials assess the effect of telemedicine on clinicians' time and to discuss how including the time needed to treat (TNT) in health technology assessment (HTA) could affect the design of telemedicine services and studies.
METHODS
We conducted a scoping review by searching clinicaltrials.gov using the search term "telemedicine" and limiting results to randomized trials or observational studies registered between January 2012 and October 2023. We then reviewed trial registration data to determine if any of the outcomes assessed in the trials measured effect on clinicians' time.
RESULTS
We found 113 studies and of these 78 studies of telemedicine met the inclusion criteria and were included. Nine (12 percent) of the 78 studies had some measure of clinician time as a primary outcome, and 11 (14 percent) as a secondary outcome. Four studies compared direct measures of TNT with telemedicine versus usual care, but no statistically significant difference was found. Of the sixteen studies including indirect measures of clinician time, thirteen found no significant effects, two found a statistically significant reduction, and one found a statistically significant increase.
CONCLUSIONS
This scoping review found that clinician time is not commonly measured in studies of telemedicine interventions. Attention to telemedicine's TNT in clinical studies and HTAs of telemedicine in practice may bring attention to the organization of clinical workflows and increase the value of telemedicine.
Topics: Telemedicine; Technology Assessment, Biomedical; Time; Appointments and Schedules
PubMed: 38099431
DOI: 10.1017/S0266462323002830 -
Dermatologic Clinics Jan 2021Telemedicine has the potential to deliver high-quality, affordable health care to underserved populations that otherwise would not have adequate access to care. The... (Review)
Review
Telemedicine has the potential to deliver high-quality, affordable health care to underserved populations that otherwise would not have adequate access to care. The authors provide a snapshot of several telemedicine initiatives that have used information and communication technologies to connect patients with health care providers across various Asian countries with differing socioeconomic statuses. They highlight several factors thought to contribute to the success of telemedicine programs, such as financial sustainability, ease of use, and utilization of existing resources. Challenges these programs have faced include lack of technological infrastructure, limitations in funding, and conflicting health system priorities.
Topics: Asia; Dermatology; Developed Countries; Developing Countries; Humans; Program Evaluation; Remote Consultation; Telemedicine; Videoconferencing
PubMed: 33228859
DOI: 10.1016/j.det.2020.08.003