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Objectives: The goal of this report was to assess telemedicine services that substitute for face-to-face medical diagnosis and treatment and that may apply to the Medicare population. We focused on three distinct telemedicine study areas—store-and-forward, self-monitoring/testing, and clinician-interactive services.
Search Strategy: We conducted two searches—a general-literature search for information about ongoing telemedicine programs, activities, and services throughout the world, and a search in the peer-reviewed literature for studies assessing the efficacy and cost of telemedicine in the study areas. The former search included literature databases, the World Wide Web, and other resources, while the latter focused on peer-reviewed articles in the MEDLINE®, EMBASE, CINAHL, and HealthSTAR databases. We also identified relevant from experts and reference lists in relevant papers.
Selection Criteria: The criterion for inclusion in the general literature review was that the article described an activity in at least one of the three study areas. The inclusion criteria for the systematic review were that the study 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 did not study the Medicare population (e.g., children and pregnant adults) or used a service that historically required face-to-face encounters (e.g., not radiology or pathology diagnosis).
Data Collection and Analysis: We used the articles included in the general-literature review to develop an inventory of relevant programs and activities. The abstracted data were entered into a relational database for aggregation and interpretation. For the systematic review, included articles were categorized by the key question(s) they addressed. For each study area, we constructed a summary table of activities and the strength of the evidence for each key question.
Main Results: A total of 455 telemedicine programs were identified, representing 30 medical specialties and serving many diverse populations. The number of telemedicine encounters has increased steadily. The evidence for the diagnostic effectiveness of store-and-forward telemedicine is strongest in dermatology. The benefit is more equivocal for other specialties, as it is for improved access, provider or patient satisfaction, and cost benefit. The evidence for self-monitoring/testing telemedicine is equivocal for all specialties, with positive results tempered by compromised study designs. The benefit of clinician-interactive telemedicine services is also questionable, with teledermatology faring less well and the results in other specialties limited by marginal study designs.
Conclusions: 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 use 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. Recent innovations in the design of randomized controlled trials for emerging technologies should be adopted. Journals publishing telemedicine-evaluation studies must set high standards for methodologic quality so that evidence reports need not rely on studies with marginal methodologies.
Telemedicine for the Medicare Population
Telemedicine for the Medicare Population—Update (February 2006)
Evidence-based Practice Center: Oregon Health & Science University
Topic Nominator: Centers for Medicare & Medicaid Services
Current as of February 2006