Clinical Care Access to Care Quality of Care Search Policies & Programs

hints
Display All Policies & Programs

Telemedicine

Health Factors: Access to Care
Decision Makers: State Government Federal Government Healthcare Professionals & Advocates Public Health Professionals & Advocates
Evidence Rating: Scientifically Supported
Population Reach: 20-49% of WI's population
Impact on Disparities: Likely to decrease disparities

Is this program or policy in use in your community? Tell us about it.

Description

Telemedicine, sometimes called telehealth, uses telecommunications technology to deliver consultative, diagnostic, and health care treatment services. Services can encompass primary and specialty care, referrals, and remote monitoring of vital signs, and may be provided via videoconference, email, smartphones, wireless tools, or other modalities (ATA). Telemedicine can supplement health care services for patients who would benefit from frequent monitoring or provide services to individuals in areas with limited access to care.

Expected Beneficial Outcomes

Increased access to care
Improved mental health
Reduced mortality
Increased medication adherence

Evidence of Effectiveness

There is strong evidence that telemedicine increases access to care (Franek 2012, Brown 2007, Wootton 2012, Clark 2007, McLean 2011, Eland-de Kok 2011, Hailey 2008, IHE-Ohinmaa 2010), especially for individuals with chronic conditions (McLean 2011, Wootton 2012) and those in rural and other traditionally underserved areas (Kehle 2011, Bashshur 2009, Penate 2012). Additional evidence is needed to determine the characteristics of the most successful telemedicine practices (Cochrane-Flodgren 2015, McLean 2011, Farmer 2005, Garcia-Lizana 2010, Hailey 2008) and better understand use in active treatments such as telestroke, teleoncology, and teledialysis (Jhaveri 2015).

Telemedicine can improve health outcomes for long-term chronic conditions such as asthma, diabetes, heart failure, COPD, and hypertension (Cochrane-Flodgren 2015, Cochrane-Kew 2016, Huang 2015, Cruz 2014, Greenwood 2014, Zhai 2014, Brown 2007, Wootton 2012, Eland-de Kok 2011), as well as mental illness (Hailey 2008, Penate 2012). Telemedicine has been shown to decrease mortality for patients with a history of chronic heart failure (Clark 2007) as effectively as usual care, and can improve blood glucose control (Cochrane-Flodgren 2015). Tele-monitoring appears to be as effective as other methods of monitoring blood glucose during pregnancy for women with pre-existing diabetes (Cochrane-Moy 2014) and may reduce unscheduled visits among women with gestational diabetes (Rasekaba 2015). It is at least as effective at treating mental health (Cochrane-Flodgren 2015) and substance abuse problems as traditional methods (Cochrane-Flodgren 2015, IHE-Ohinmaa 2010).

Telephone interventions appear to increase medication adherence in individuals with HIV infection and reduce risky sexual behavior, but further research is needed to determine effects on health outcomes (Cochrane-Gentry 2013). Telemedicine appears to be an effective way to treat children and adolescents (dos Santos 2014), and monitor the health of older adults (van den Berg 2012). Telemedicine may reduce physician-related medication errors among seriously ill or injured children in rural emergency departments (Dharmar 2013), and can increase medication adherence when used in home health care virtual visits (Husebo 2014).

Telerehabilitation services may improve motor function following total knee replacement (Agostini 2015) and reduce short-term disability and symptoms for patients with multiple sclerosis (Cochrane-Khan 2015). Telerehabilitation also appears to produce similar outcomes to center-based cardiac rehabilitation for low to moderate risk coronary artery disease patients (Huang 2015a). Teleglaucoma screening detects more cases of glaucoma than in-person screening in remote and underserved communities (Thomas 2014b), and, overall, telemedicine appears to increase access to care for speech, language, and hearing services (Molini-Avejonas 2015).

Telemedicine appears to be a cost effective way to deliver care (Yang 2015, Jennett 2003). Once the technology is in place, providing care through telemedicine may be less costly than standard care (Henderson 2013). However, high initial implementation costs and limited payment policies can be barriers to establishing telemedicine programs (Henderson 2013, Brown 2007).

Implementation

United States

As of December 2015, 48 states and the District of Columbia provide Medicaid reimbursement for at least some telehealth services, and 32 states and the District of Columbia have telehealth private payer laws (NCSL-Telehealth).

A number of telemedicine and telehealth programs exist in the United States (HRSA-Telehealth programs). The Missouri Telehealth Network (MTN), for example, is aimed at enhancing access to care in underserved areas of Missouri. The Children’s National Medical Center in Washington DC has a telemedicine program that serves community hospitals, suburban health centers, inner-city health clinics, national hospitals, and international partners (CNHS-Telemedicine).

As of December 2014, 41 states and Washington, DC have a law defining telemedicine practices; 24 states and Washington, DC have laws allowing primary care providers to deliver care via telehealth (LawAtlas-Telehealth).

Wisconsin

Marshfield Clinic TeleHealth was started 1997. The network now consists of the Marshfield hub and 11 smaller sites in rural Wisconsin (Marshfield-Telehealth).

Implementation Resources

ATA - American Telemedicine Association (ATA). Accessed on June 6, 2016
HRSA-Telehealth - Health Resources and Services Administration (HRSA). Telehealth. Accessed on June 6, 2016
LawAtlas-Telehealth - LawAtlas. Telehealth and primary care provider laws map. Accessed on June 6, 2016
SNI-Telehealth 2009 - California Health Care Safety Net Institute (SNI). Telemedicine resource guide. Oakland: California Health Care Safety Net Institute (SNI); 2009. Accessed on June 6, 2016

Citations - Description

ATA - American Telemedicine Association (ATA). Accessed on June 6, 2016

Citations - Evidence

Agostini 2015* - Agostini M, Moja L, Banzi R, et al. Telerehabilitation and recovery of motor function: A systematic review and meta-analysis. Journal of Telemedicine and Telecare. 2015;21(4):202–213. Accessed on June 6, 2016
Bashshur 2009 - Bashshur RL, Shannon GW. National telemedicine initiatives: Essential to healthcare reform. Telemedicine Journal and e-Health. 2009;15(6):600-10. Accessed on June 6, 2016
Brown 2007 - Brown LL, Lustria MLA, Rankins J. A review of web-assisted interventions for diabetes management: Maximizing the potential for improving health outcomes. Journal of Diabetes Science and Technology. 2007;1(6):892–902. Accessed on June 6, 2016
Clark 2007 - Clark RA, Inglis SC, McAlister FA, Cleland JG, Stewart S. Telemonitoring or structured telephone support programmes for patients with chronic heart failure: Systematic review and meta-analysis. BMJ. 2007;334(7600):942. Accessed on June 6, 2016
Cochrane-Flodgren 2015* - Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: Effects on professional practice and health care outcomes (Review). Cochrane Database of Systematic Reviews. 2015;(9):CD002098. Accessed on June 6, 2016
Cochrane-Gentry 2013 - Gentry S, van-Velthoven MH, Tudor CL, Car J. Telephone delivered interventions for reducing morbidity and mortality in people with HIV infection. Cochrane Database of Systematic Reviews. 2013;(5):CD009189. Accessed on June 6, 2016
Cochrane-Kew 2016* - Kew KM, Cates CJ. Remote versus face-to-face check-ups for asthma (Review). Cochrane Database of Systematic Reviews. 2016;(4):CD011715. Accessed on June 6, 2016
Cochrane-Khan 2015* - Khan F, Amatya B, Kesselring J, Galea M. Telerehabilitation for persons with multiple sclerosis (Review). Cochrane Database of Systematic Reviews. 2015;(4):CD010508. Accessed on June 6, 2016
Cochrane-Moy 2014* - Moy FM, Ray A, Buckley BS. Techniques of monitoring blood glucose during pregnancy for women with pre-existing diabetes (Review). Cochrane Database of Systematic Reviews. 2014;(4):CD009613. Accessed on June 6, 2016
Cruz 2014* - Cruz J, Brooks D, Marques A. Home telemonitoring effectiveness in COPD: A systematic review. International Journal of Clinical Practice. 2014;68(3):369–378. Accessed on June 6, 2016
Dharmar 2013 - Dharmar M, Kuppermann N, Romano PS, et al. Telemedicine consultations and medication errors in rural emergency departments. Pediatrics. 2013;132(6):1090-1097. Accessed on June 6, 2016
dos Santos 2014 - dos Santos MTN, Moura SCDO, Gomes LMX, et al. Telehealth application on the rehabilitation of children and adolescents. Revista paulista de pediatria: orgão oficial da Sociedade de Pediatria de São Paulo. 2014;32(1):136–43. Accessed on June 6, 2016
Eland-de Kok 2011* - Eland-de Kok P, van Os-Medendorp H, Vergouwe-Meijer A, Bruijnzeel-Koomen C, Ros W. A systematic review of the effects of e-health on chronically ill patients. Journal of Clinical Nursing. 2011;20(21/22):2997-3010. Accessed on June 6, 2016
Farmer 2005* - Farmer A, Gibson OJ, Tarassenko L, Neil A. A systematic review of telemedicine interventions to support blood glucose self-monitoring in diabetes. Diabetic Medicine. 2005;22(10):1372-8. Accessed on June 6, 2016
Franek 2012 - Franek J. Home telehealth for patients with chronic obstructive pulmonary disease (COPD): An evidence-based analysis. Ontario Health Technology Assessment Series. 2012;12(11):1–58. Accessed on June 6, 2016
Garcia-Lizana 2010* - García-Lizana F, Muñoz-Mayorga I. Telemedicine for depression: A systematic review. Perspectives in Psychiatric Care. 2010;46(2):119-26. Accessed on June 6, 2016
Greenwood 2014 - Greenwood DA, Young HM, Quinn CC. Telehealth remote monitoring systematic review: Structured self-monitoring of blood glucose and impact on A1C. Journal of Diabetes Science and Technology. 2014;8(2):378–389. Accessed on June 6, 2016
Hailey 2008* - Hailey D, Roine R, Ohinmaa A. The effectiveness of telemental health applications: A review. Canadian Journal of Psychiatry. 2008;53(11):769-78. Accessed on June 6, 2016
Henderson 2013 - Henderson C, Knapp M, Fernandez JL, et al. Cost effectiveness of telehealth for patients with long term conditions (whole systems demonstrator telehealth questionnaire study): Nested economic evaluation in a pragmatic, cluster randomised controlled trial. BMJ. 2013;346:f1035. Accessed on June 6, 2016
Huang 2015 - Huang Z, Tao H, Meng Q, Jing L. Effects of telecare intervention on glycemic control in type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. European Journal of Endocrinology. 2015;172(3):R93-R101. Accessed on June 6, 2016
Huang 2015a* - Huang K, Liu W, He D, et al. Telehealth interventions versus center-based cardiac rehabilitation of coronary artery disease: A systematic review and meta-analysis. European Journal of Preventive Cardiology. 2015;22(8):959-971. Accessed on June 6, 2016
Husebo 2014* - Husebø AML, Storm M. Virtual visits in home health care for older adults. The Scientific World Journal. 2014;2014:689873. Accessed on June 6, 2016
IHE-Ohinmaa 2010 - Ohinmaa A, Chatterley P, Nguyen T, Jacobs P. Telehealth in substance abuse and addiction: Review of the literature on smoking, alcohol, drug abuse and gambling. Alberta, CAN: Institute of Health Economics (IHE); 2010. Accessed on June 6, 2016
Jennett 2003* - Jennett PA, Affleck Hall L, Hailey D, et al. The socio-economic impact of telehealth. Journal of Telemedicine and Telecare. 2003;9(6):311-320. Accessed on June 6, 2016
Jhaveri 2015* - Jhaveri D, Larkins S, Sabesan S. Telestroke, tele-oncology and teledialysis: A systematic review to analyse the outcomes of active therapies delivered with telemedicine support. Journal of Telemedicine and Telecare. 2015;21(4):181–188. Accessed on June 6, 2016
Kehle 2011 - Kehle SM, Greer N, Rutks I, Wilt T. Interventions to improve veterans’ access to care: A systematic review of the literature. Journal of General Internal Medicine. 2011;26(Suppl 2):689-96. Accessed on June 6, 2016
McLean 2011* - McLean S, Protti D, Sheikh A. Telehealthcare for long term conditions. BMJ. 2011;342:d120. Accessed on June 6, 2016
Molini-Avejonas 2015* - Molini-Avejonas DR, Rondon-Melo S, Albuquerque de La Higuera Amato C, Samelli AG. A systematic review of the use of telehealth in speech, language and hearing sciences. Journal of Telemedicine and Telecare. 2015;21(7):367–376. Accessed on June 6, 2016
Penate 2012 - Peñate W. About the effectiveness of telehealth procedures in psychological treatments. International Journal of Clinical and Health Psychology. 2012;12(3):475–87. Accessed on June 6, 2016
Rasekaba 2015* - Rasekaba TM, Furler J, Blackberry I, et al. Telemedicine interventions for gestational diabetes mellitus: A systematic review and meta-analysis. Diabetes Research and Clinical Practice. 2015;110(1):1–9. Accessed on June 6, 2016
Thomas 2014b* - Thomas SM, Jeyaraman M, Hodge WG, et al. The effectiveness of teleglaucoma versus in-patient examination for glaucoma screening: A systematic review and meta-analysis. PLoS ONE. 2014;9(12):e113779. Accessed on June 6, 2016
van den Berg 2012* - van den Berg N, Schumann M, Kraft K, Hoffmann W. Telemedicine and telecare for older patients: A systematic review. Maturitas. 2012;73(2):94–114. Accessed on June 6, 2016
Wootton 2012 - Wootton R. Twenty years of telemedicine in chronic disease management - An evidence synthesis. Journal of Telemedicine and Telecare. 2012;18(4):211–20. Accessed on June 6, 2016
Yang 2015* - Yang NH, Dharmar M, Yoo BK, et al. Economic evaluation of pediatric telemedicine consultations to rural emergency departments. Medical Decision Making. 2015;35(6):773–783. Accessed on June 6, 2016
Zhai 2014* - Zhai, Y, Zhu W, Cai Y, Sun D, Zhao J. Clinical- and cost-effectiveness of telemedicine in type 2 diabetes mellitus: A systematic review and meta-analysis. Medicine (Baltimore). 2014;93(28):e312. Accessed on June 6, 2016

Citations - Implementation

CNHS-Telemedicine - Children’s National Health System (CNHS). Telemedicine. Accessed on June 6, 2016
HRSA-Telehealth programs - Health Resources and Services Administration (HRSA). Telehealth programs. Accessed on June 6, 2016
LawAtlas-Telehealth - LawAtlas. Telehealth and primary care provider laws map. Accessed on June 6, 2016
Marshfield-Telehealth - Marshfield Clinic. Telehealth. Accessed on June 6, 2016
MTN - Missouri Telehealth Network (MTN). Improving health with telecommunications technology. Accessed on June 6, 2016
NCSL-Telehealth - National Conference of State Legislatures (NCSL). State coverage for telehealth services. Accessed on June 6, 2016

Page Last Updated

June 6, 2016

* Journal subscription may be required for access.