The effectiveness of telehealth services has been examined in the literature in relation to clinical effectiveness, economic benefits and workforce/professional development. None of the studies found in the literature review were able to conclusively demonstrate the full impact of telehealth services in relation to traditional medical services. A recent literature review that examined telehealth services in Australia found that there were significant benefits, both for the patients and the carers.

Moffatt and Elay (2010) conducted a literature review to identify the reported benefits attributed to telehealth for people living in, and professionals working in, rural and remote areas of Australia. Patients are reported to have benefited from lower costs and reduced inconvenience while accessing specialist health services and improved access to services and improved quality of clinical services. Health professionals benefited from access to continuing education and professional development, provision of enhanced local services and experiential learning, networking and collaboration. The review findings suggest that one strategy, the increased use of telehealth, has the potential to reduce the inequitable access to health services and the poorer health status that many rural Australians experience, and contribute to addressing the on-going problem of the recruitment and retention of the rural health workforce.

The evidence from this review suggests that there are significant opportunities for telemedicine to both reduce the cost of health care and to increase the equity of service across Australia. While the potential benefits of telemedicine appear to be large, there is still significant gaps of where telemedicine services are most effective, both in terms of clinical and cost effectiveness. There have been several recent reviews of telemedicine services in relation to specific disease areas. The evidence from these reviews is promising but shows that not all disease areas or interventions are appropriate for telemedicine.

Johansson and Wild (2011) conducted a systematic review of telerehabilitation interventions in stroke care based on nine studies, all published after 2000. There were four randomized controlled trials and one qualitative analysis identified. The authors found that home-based telerehabilitation interventions showed promising results in improving the health of stroke patients and in supporting caregivers. Also, telemedicine systems based on a virtual environment for upper extremity exercise can improve the physical health of stroke patients and health professionals, with participants reporting high levels of satisfaction and acceptance of telerehabilitation interventions. However, there was no evidence regarding the effects on resource utilization or cost-effectiveness. Most studies showed promising results, although overall, the quality of the evidence on telerehabilitation in post-stroke care was low.

A review of systematic reviews of the impacts and costs of telemedicine services was undertaken by Ekeland et al. (2010). Interventions included all e-health interventions, information and communication technologies for communication in health care, Internet based interventions for diagnosis and treatments. 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. The authors concluded that 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.

McLean et al. (2011), reviewed studies of the effectiveness of telehealthcare for COPD compared with usual face-to-face care. Telehealthcare was associated with a clinically significant increase in quality of life in two trials with 253 participants and showed a significant reduction in the number of patients with one or more emergency department attendances over 12 months. There was no significant difference in the odds ratio (OR) for deaths over 12 months for the telehealthcare group as compared to the usual care group in three trials with 503 participants; OR 1.05 (95% CI 0.63 to 1.75). The authors concluded that Telehealthcare in COPD appears to have a possible impact on the quality of life of patients and the number of times patients attend the emergency department and the hospital. However, further research is needed to clarify precisely its role since the trials included telehealthcare as part of more complex packages. In summary, this study showed that people treated this way do manage to stay out of hospital longer than people treated by conventional systems of care. There are also some data showing that although these systems are expensive to start off with, if they are successful at keeping people out of hospital, then the cost saving from this provides long term reductions in cost.Top of page

Kidd et al (2010) reviewed telehealth applications in palliative care settings in the UK. In total, 111 papers were identified and 21 documents were included in the review. Telehealth was being used by a range of health professionals in oncology care settings that included specialist palliative care, hospices, primary care settings, nursing homes and hospitals as well as patients and carers. The most common applications were: out-of-hours telephone support, advice services for palliative care patients, carers and health professionals, videoconferencing for interactive case discussions, consultations and assessments, and training and education of palliative care and other healthcare staff. The review suggests that current technology is usable and acceptable to patients and health professionals in palliative care settings.

Currell et al. (2000) reviewed seven trials involving more than 800 people. One trial was concerned with telemedicine in the emergency department, one with video-consultations between primary health care and the hospital outpatients department, and the remainder were concerned with the provision of home care or patient self-monitoring of chronic disease. The studies appeared to be well conducted, although patient numbers were small in all but one. Although none of the studies showed any detrimental effects from the interventions, neither did they show unequivocal benefits or provide evidence for the safety of telemedicine. None of the studies included formal economic analysis. The authors concluded that establishing systems for patient care using telecommunications technologies is feasible, but there is little evidence of clinical benefits. The studies provided variable and inconclusive results for other outcomes such as psychological measures, and no analysable data about the cost effectiveness of telemedicine systems. The review demonstrates the need for further research.

Wootten et al (2008) examined the benefits of telemedicine in relation to reductions in travel time for dermatology patients. The authors completed a literature search to find studies that directly examined the effect of travel time and then developed a regression model to determine the net effect of telemedicine services on patient travel. Very few of the studies that the authors found included a controlled trial of telemedicine services and therefore they decided to integrate all credible evidence on travel time to understand the effects of teledermatology. The authors found that for dermatology there were two types of telemedicine utilised, store and forward, using images transmitted to doctors through the electronic communication or real time services provided by doctors. Store and forward services are cheaper than real time telemedicine and the mean avoided travel in studies that examined this type of service was 43%. Real time telemedicine was found on average to reduce travel by 70%, which was found to be a statistically significant increase over store and forward. The authors concluded that both methods provided significant benefit and that understanding the difference between these services can help health planners to make decisions on the potential benefits of providing these services to patients.

Further study is obviously required to fully understand the role that telemedicine will play in future clinical care models. From the perspective of the system as a whole, understanding the economic impact of telemedicine services will be required to inform how the services should be funded and promoted within the health system. Unfortunately, there is significantly less evidence around the economic effects of telemedicine services.Top of page