A Systematic Review of Economic Analyses of Telehealth Services Using Real Time Video Communication
Original Paper
Abstract
Background: In recent decades, advances in information engineering have given new momentum to telemedicine research. These advances in telemedicine range from private to population levels, allowing the commutation of patient information for diagnosis and management of health problems, main care prevention, and instruction of physicians via distance learning.
Objective: This scientometric investigation aims to examine collaborative inquiry networks, ascendant research themes and disciplines, and seminal research studies that have contributed most to the field of telemedicine. This information is vital for scientists, institutions, and policy stakeholders to evaluate research areas where more infrastructural or scholarly contributions are required.
Methods: For analyses, we used CiteSpace (version iv.0 R5; Drexel University), which is a Java-based software that allows scientometric assay, particularly visualization of collaborative networks and research themes in a specific field.
Results: We found that scholarly activeness has experienced a significant increase in the concluding decade. Almost important works were conducted by institutions located in loftier-income countries. A bailiwick-specific shift from radiology to telestroke, teledermatology, telepsychiatry, and chief care was observed. The virtually important innovations that yielded a collaborative influence were reported in the following medical disciplines, in descending order: public environmental and occupational wellness, psychiatry, pediatrics, health policy and services, nursing, rehabilitation, radiology, pharmacology, surgery, respiratory medicine, neurosciences, obstetrics, and elderliness.
Conclusions: Despite a continuous rise in scholarly activeness in telemedicine, we noticed several gaps in the literature. For instance, all the chief and secondary research central to telemedicine was conducted in the context of high-income countries, including the testify synthesis approaches that pertained to implementation aspects of telemedicine. Furthermore, the inquiry landscape and implementation of telemedicine infrastructure are expected to run across exponential progress during and subsequently the COVID-xix era.
doi:10.2196/18835
Keywords
Introduction
Advances in data and communication technologies (ICTs) have about reduced the globe to a global village. The recent progress in ICTs has also shown incredible promise in addressing significant challenges in health intendance in disparate regions worldwide. Specifically, telemedicine ensures the provision of accessible, cost-effective, and specialized health care services in disparate areas. Co-ordinate to the Earth Health Organization (WHO), telemedicine pertains to the delivery of health care using unlike modalities embedded in the realms of information and communication technologies. Information technology aims to advance health care, ranging from individual to population levels, past allowing substitution of patient information for diagnosis and management of health problems, primary care prevention, and educational activity of physicians via distance learning []. Telemedicine is a new aqueduct for wellness care services, which also enables opportunities to strengthen collaborative research.
The earliest evidence for telemedicine can exist traced back to a clinical study published in The Lancet in 1879, which described the successful diagnosis of a child over the telephone []. In addition, use of telegraphs was also evident in the American Civil War for transfer of mortality data and remote delivery of medical care []. A fine example of telemedicine was seen when, 20 years agone, the National Aeronautics and Space Administration monitored the astronauts' well-being during the Apollo mission to the moon. The modern form of telemedicine, however, appeared with the appearance and maturation of the cyberspace, which fabricated possible the utilize of videoconferencing, high-quality information transfer, and distance learning platforms at a lower cost. The potential of telemedicine in strengthening health systems was as well recently recognized past the WHO, leading to the establishment of the Global Observatory for eHealth in 2005 []. In 2009, the telemedicine module of the Global Observatory for eHealth mapped the evolution of telemedicine in iv specialties of medicine—pathology, radiology, psychology, and dermatology—in 114 fellow member states. This report found that the greatest development had been fabricated in the provision of teleradiology services (33%) among the WHO member states, while xx% of the countries reported conducting a national review or evaluation of telemedicine. In addition, 50% of the member states reported that they had institutions dedicated to the development of telemedicine solutions [].
The most recent study by the WHO, published in 2016, emphasized the part of eHealth in achieving universal health coverage []. The development of telemedicine was constitute crucial in the attainment of sustainable evolution goal 8, "achieve universal wellness coverage," and goal 3, "ensure good for you lives and promote well-being for all at all ages," thus ensuring health for all, regardless of creed, ethnicity, color, or finances. It also identified a rapid progress among its member states from 2010 to 2016. At least 83% of the countries had reported a mobile wellness (mHealth) initiative, widespread employ of teleradiology (from 33% to 77%), telepathology or teledermatology (about l%), and telepsychiatry (33%). In addition, e-learning initiatives were reported in 84% of countries and the utilise of national electronic wellness records in 47% of the member states, and 78% of the countries reported legislations ensuring privacy of the electronic data. However, similar to the previous survey, very few countries had conducted evaluations of mHealth programs, which limits our understanding of the use of telemedicine, its barriers and facilitators, and which elements actually work []. These reports are a milestone in the field of telemedicine. Still, these were dependent on data provided past government organizations and were heavily focused on government-run telehealth initiatives [].
While the WHO-commissioned reports and evidence synthesis publications were indispensable in gauging worldwide infrastructure and legislation in telemedicine, scholarly research is a true marker for progress and evolution in every scientific field, and it is crucial to map research output in the field of telemedicine to determine prevalent research themes in guild to guide policy makers and funders to improve or restrict menstruation of funding when required. Recognizing the importance of mapping progress in a field, scientists have devised several reproducible statistical methods that form the disciplines of bibliometrics and scientometrics. Scientometrics is divers as the "quantitative written report of science, communication in science, and scientific discipline policy" [], and it helps evaluate the affect of journals, scientists, and institutions on the development and innovation of a scientific field.
Several studies published recently have used bibliometric methods to written report progress in telemedicine, albeit in a very narrow context. For instance, Fatehi and Wootton [] focused on delineating the use of different terminology to draw telemedicine, Groneberg et al [] detailed the country-specific publication output and annual trends of publication and citation outputs, Gu et al [] described the intellectual structure of telemedicine research by focusing on collaborative networks between different countries and authors, and Askari et al [] provided an overview of the pinnacle sixty most often cited studies in telemedicine-specific journals. At that place is, still, a paucity of studies providing a holistic snapshot of advances in telemedicine from 2010 to 2019. The nowadays analysis leverages the use of scientometric techniques to analyze publication output in the field of telemedicine worldwide, regardless of the government, industrial, or academic affiliations.
Methods
Bibliographic Search
An academic search of the Web of Science (WOS) cadre database was performed covering January 2010 to December 2019 to retrieve English language papers, using the following keyword: TS=(telemedicine). We restricted our search results to papers published in English only. The bibliographic records of these studies, including titles, abstracts, writer details, affiliations, keywords, and citing references, were downloaded. We restricted our search results to the terminal 10 years to restrict our analyses in order to achieve a snapshot of recent research activity in telemedicine. The WOS cadre database was used for this academic search for two of import reasons: it provides large coverage of over xx,000 peer-reviewed journals pertaining to 250 disciplines in health and social sciences and engineering and it is the only database that allows curation of citing references of each indexed publication to let cocitation analyses.
Operational Definitions
Telemedicine literally means "healing at a distance." However, there are no definitive definitions of telemedicine, with a recent review reporting over 104 peer-reviewed definitions found in the literature []. However, for the purpose of this scientometric investigation, nosotros adapted a definition of telemedicine embodying iv crucial elements: (1) provision of clinical support, (2) connection of users from different concrete locations, (iii) improved health outcomes, and (4) employ of ICT [,].
Knowledge Visualization Analyses
For analyses, we used CiteSpace (version 4.0 R5; Drexel University), which is a Java-based software that allows scientometric analysis, especially visualization of collaborative networks and research themes in a specific field [,]. The visualization of these collaborative networks in a subject area is based on the theory of cocitation, which posits that 2 documents share a cocitation relationship when they are cited together past another document [,]. For mapping of these networks, we ran network analyses using the cosine link reduction method and pathfinder networking scaling. Term sources were set as titles, abstracts, and author keywords, while nodes were set as cited references to delineate collaborative networks and cluster analyses. The time-splicing method was used to explore publications in ii periods, 2010 to 2014 and 2015 to 2019, where each slice comprised the top 50 cited papers every year.
To obtain clusters or themes of inquiry, nosotros ran cluster analyses in which each cluster was termed co-ordinate to publication keywords using 2 text-mining methods: term frequency-inverse document frequency (TF-IDF) and log likelihood ratio (LLR). The first method, TF-IDF, uses terms that are weighted by term frequencies multiplied by inverted document frequencies [,]. LLR tests choose the almost appropriate clustering label past assessing the strength of the bond between a term and a cluster [,]. A cluster is said to be parsimonious when information technology comprises a larger number of items and an acceptable silhouette and modularity value (Q). The silhouette value is a measure of how similar an object is to its own cluster (cohesion) compared with other clusters (separation) [,]. The value of Q and silhouette ranges between –1 to 1, where a value closer to 1 is considered acceptable.
Each paper is presented as a node and links between two nodes as edges. The collaborative network mapped from this analysis yields several of import results. Any inquiry report with axis values ≥0.1 are considered influential in their collaborative networks. Citation rings show annual citation patterns, while majestic nodes stand for landmark theories or works that requite rise to a new trunk of piece of work. Citation bursts revealing short periods of high scholarly activity are presented as reddish rings. Based on these cues, researchers can place of import works in a field and important themes of research.
Results
Bibliometrics
Web of Science (core database) yielded 6896 publications from 2010 to 2019, with a total h-index of 87 and an average 10.64 citations per study. These were cited a total of 73,354 times past a total of 42,381 citing papers. There was an increasing trend in both the publication and citation output from 2010 to 2019 ().
Regional Trends in Telemedicine Research
Regionally, the highest publication output (in English) was contributed past high-income countries: the U.s.a., Australia, England, Canada, and Deutschland. At that place were 2 middle-income countries, Republic of india and the People's Republic of China, that besides ranked in the pinnacle x for publication output. Yet, in terms of having a centrality score of 0.i or greater, 6 countries—England, France, Belgium, Portugal, the People's Republic of Red china, and Greece—appeared to agree significant influence in worldwide collaborations in telemedicine. These countries are likewise presented every bit purple nodes in (ie, contributing groundbreaking inquiry). These central nations, although mainly high-income countries, likewise formed collaborations with a number of low- and eye-income countries (LMICs), such as Ethiopia, Mali, Botswana, Nepal, Zimbabwe, Pakistan, and Uganda.
Institutional Trends in Telemedicine Research
Among institutions, the top 9 contributing institutions in terms of publication output were based in the United States, including the University of California organisation (n=304), Harvard University (n=227), and the Pennsylvania Republic System of College Pedagogy (n=152). Outside of the United States, the University of Queensland in Australia was the fifth-highest contributing region. Institutions with centrality ≥0.1 included Columbia Academy, University of Queensland, Academy of Toronto, and Karolinska Institute. It is noteworthy that none of the top ix U.s. institutions in terms of publication output were deemed important in their collaborative networks ().
Bailiwick-Specific Trends in Telemedicine Enquiry
An assay of the Web of Science revealed that the disciplines of health care sciences and services (due north=2338) and medical informatics (north=835) reported the highest number of publication items. However, a total of 19 disciplines had the greatest axis values (≥0.i). Nigh important innovations yielding a collaborative influence were reported in the following medical disciplines, in descending order: public environmental and occupational health, psychiatry, pediatrics, health policy and services, nursing, rehabilitation, radiology, pharmacology, surgery, respiratory medicine, neurosciences, obstetrics, and geriatrics ().
Keyword Analysis in Telemedicine
A full of 106 research keywords were identified in the field of telemedicine, revealing the most-researched topics (). From 2010 to 2019, 32 keywords appeared to have citation outbursts showing the greatest research activity in telemedicine (). The top 50 cited keywords in tandem with citation outbursts were divided into themes to place the most ofttimes researched diseases, outcomes, study designs, and populations, shown in .
| Theme | Most frequent keywords |
| Diseases | Diabetic retinopathy, stroke, depression, centre failure, rehabilitation, thrombolysis |
| Performance indicators | Feasibility, accuracy, reliability, barrier, adherence, satisfaction, performance, price-effectiveness |
| Outcomes | Self-direction, support, impact, diagnosis, educational activity, bloodshed, quality of life, telemonitoring |
| Study design | Association, follow-upwardly, meta-analysis, randomized controlled trials, implementation, prevalence |
| Disciplines | Telestroke, teledermatology, telepsychiatry, primary intendance |
| Setting | Home, internet, videoconferencing, communication, telecommunication, smartphone |
| Population | Veterans, United States, children |
Clusters of Enquiry in Telemedicine From 2009 to 2014
From 2009 to 2014, a total of 2527 papers were published, which were cited past 141,702 references. These were analyzed to study landmark publications and clusters of research during this flow. There was a total of 228 nodes and 273 edges. Cluster analysis yielded a parsimonious network of clusters () with a modularity of 0.85 and silhouette value of 0.42. It yielded a total of 56 clusters, out of which viii comprised at to the lowest degree 10 studies each and an acceptable silhouette value (range 0.85 to 1.0).
Acute Medicine
Stroke
The zeroth cluster comprised 32 items with a silhouette value of 0.98, described past terms such equally information technology (TF-IDF) and acute ischemic stroke and thrombolysis (LLR). The tertiary cluster pertained to mobile stroke units (TF-IDF) and associated mortality and economic outcomes (LLR).
Telecardiology
The 2d cluster pertained to telemonitoring at home (TF-IDF) for chronic diseases such as middle failure (LLR). The fifth cluster was focused on clinical direction and home monitoring (TF-IDF) of pacemaker activity and implantable cardioverter defibrillator (LLR), especially in patients with myocardial infarction.
Chronic Diseases
Diabetes
Cluster seven pertained to general practitioner–mediated telecardiology (TF-IDF) and user acceptance of this plan (LLR). The 6th cluster pertained to nutrition in diabetes, especially in the context of the Columbia University Information science for Diabetes Teaching and Telemedicine project.
Telepsychiatry
The tertiary cluster was defined as neuropsychological assessment (past TF-IDF method), focusing on posttraumatic stress disorder (PTSD) and cognitive behavioral therapy (LLR method).
Respiratory Medicine
This cluster (the fifth cluster) pertained to self-direction of chronic obstructive pulmonary affliction (COPD) and its exacerbation (TF-IDF and LLR).
Landmark Publications From 2009 to 2014
The period from 2009 to 2014 revealed 10 landmark publications pertaining to different themes, where most of the publications pertained to intensive care, especially stroke () [-]. Audebert et al published three important studies [-] demonstrating the success of the telemanagement of stroke in rural hospitals in Bavaria, Germany. In a like context, Schwamm et al [] provided evidence for telestroke consultations via videoconferencing and Lilly et al [] showed that the implementation of a tele–intensive care unit of measurement (ICU) intervention was associated with reduced adjusted odds of mortality and reduced length of hospital stay, also as with changes in best-practice adherence and lower rates of preventable complications. In their cantankerous-sectional survey, Silva et al [] described the status of telestroke programs in the United States. In add-on, 2 important literature reviews were published during this flow. Sood et al [] improved our understanding of the theoretical underpinnings of modern telemedicine subsequently a conscientious evaluation of 104 peer-reviewed publications, while Kahn et al [] summarized the recommendations of a working grouping for the adoption of a standardized framework for the standardized acquit of tele-ICU studies. Lastly, May et al [] described the complexity that exists in the calibration-upward of telemedicine programs, which is oft underestimated, leading to their failures.
| Writer (yr) | Study design | Theme | Affliction | Lesson learned |
| Broens (2007) []a | Qualitative literature review | Implementation | N/Ab | Determinants of successful implementation and scale-upwardly of telemedicine programs. Important determinants of telemedicine programs include (1) technology, (2) acceptance, (iii) financing, (iv) organization, and (5) policy and legislation. |
| Schwamm et al (2004) [] | Retrospective | Feasibility | Stroke | Telestroke consultation via videoconferencing improved care in 95% of the cases. |
| Silva et al (2012) []a | Cross-sectional survey | Barriers and facilitators | Stroke | Condition of telestroke in the United states. The top 3 clinical needs met by telestroke were emergency department consultation (100%), patient triage (83.8%), and inpatient teleconsultation (46.0%). |
| Kahn et al (2011) []a | Working group argument | Guidelines | Intensive care | This working group meeting was convened to address methodological and knowledge gaps in the field. Information technology proposed adoption of a common framework to facilitate standardized carry of telemedicine studies in the ICUc. |
| Audebert et al (2005) [] | Retrospective | Feasibility | Stroke | Telemedicine provided a cost-constructive method to recommend use of thrombolysis among patients presenting with stroke in rural regions. |
| Lilly et al (2011) []a | Prospective stepped-wedge clinical trial | Effectiveness | Intensive care | Implementation of a tele-ICU intervention was associated with reduced adjusted odds of mortality and reduced length of infirmary stay, equally well as with changes in best-practice adherence and lower rates of preventable complications. |
| May et al (2003) [] | Qualitative study | Implementation | Northward/A | Complication exists at 4 discrete levels in whatever given telehealth context: implementation, adoption, translation, and stabilization. This complexity is oft underestimated, leading to failed scale-ups. |
| Sood et al (2007) []a | Literature review | Theoretical underpinnings | Northward/A | Divers modern telemedicine later on a careful review of 104 publications. |
| Audebert et al 2006 [] | Prospective | Feasibility | Stroke | The telestroke concept promises better coverage of systemic thrombolysis in nonurban areas. |
| Audebert et al 2006 []a | Nonrandomized clinical trial | Trial | Stroke | Handling in rural hospitals independently reduced the probability of a poor consequence compared with controls. |
aPurple nodes in representing seminal work in the surface area of telemedicine.
bN/A: not applicative.
cICU: intensive care unit of measurement.
Clusters of Research in Telemedicine From 2015 to 2019
From 2015 to 2019, a full of 4493 records were published, which were cited a total of 141,702 times. Cluster analyses yielded a parsimonious cluster network with a modularity of 0.69 and a silhouette value of 0.39. To get a snapshot of research themes in this catamenia, nosotros analyzed a total of 205 nodes with 345 edges. A total of 27 clusters of research in telemedicine were identified, out of which 12 had an adequate silhouette value. In size, these clusters ranged from 8 to 23 studies, and modularity values ranged from 0.97 to 0.71. These clusters barbarous into 4 major themes: (ane) clinical decision back up systems, (ii) reliability, (iii) access to health care, and (iv) medical weather ().
Clinical Decision Support Systems
The zeroth cluster pertained to clinical decision back up systems to aid in self-management (TF-IDF), explored in the context of ulcerative colitis (LLR) and lung cancer (mutual data).
Reliability
A total of 2 clusters (one and 8) focused on reliability and interexpert agreement (TF-IDF) pertaining to telemedicine-aided diagnoses mediated by general practitioners (TF-IDF), especially in the field of teledermatology (LLR).
Access to Wellness Care
A total of iii clusters (2, 3, and ix) pertained to this thematic area of telemedicine, defined by access to telemedicine in shortage areas (TF-IDF) to help in the diagnosis of diabetic retinopathy. Rural health intendance was an important component of this research theme, where the issue of switching fourth dimension between pediatric consultations was thoroughly researched.
Medical Conditions
A total of four clusters (4, v, half dozen, and vii) focused on both acute and chronic conditions, for instance, general practitioner–mediated mental health care, especially in PTSD. Cluster 5 pertained to telecardiology, in which heart failure, remote monitoring of pacemaker activity, and patient satisfaction were important areas of research. In accordance with research prior to 2015, acute ischemic stroke and thrombolysis were important research areas in telestroke. In the specialty of tele-ICU, the care of critically sick patients, particularly those undergoing liver transplantation, and economical outcome were the well-nigh researched areas.
End Consumer Research
Patient compliance, safety, and satisfaction were explored in 2 clusters (10 and 11).
Landmark Publications From 2015 to 2019
This menses of scholarly activity in telemedicine continued to be influenced by iv studies published prior to 2015 [,,-], pertaining to tele-ICU, telestroke, tele–mental wellness, and facilitators and barriers to telemedicine. The bulk of publications unique to this time period were literature reviews, systematic or otherwise (n=10), followed by retrospective studies (n=2) and a clinical trial (northward=1). Major themes in this era were effectiveness and cost-effectiveness inquiry (both chief and secondary). In add-on, the connected wellness model of wellness care, which governs telemedicine, and the standardized framework for cess of telemedicine deputed past the European Commission were deemed central in these collaborative networks.
The well-nigh influential review in this flow pertained to chronic diseases and was an evidence synthesis written report on 141 randomized controlled trials relating to asthma, COPD, diabetes, heart failure, and hypertension []. Information technology reported stiff evidence of publication bias, with 108 randomized controlled trials reporting positive results and almost none reporting harm []. Wade et al [] presented a systematic review regarding economic analysis of telemedicine and concluded that the delivery of health services by existent-time video communication was price-effective for home care and access to on-call hospital specialists.
Effectiveness research was conducted using both primary interventional and evidence synthesis approaches. For example, Chaudhry et al [] conducted a clinical trial and showed that telemonitoring did not improve outcomes among patients hospitalized for center failure. In their reviews, Ekeland et al [] and Flodgren et al [] examined effectiveness of telemedicine in multiple conditions [,]; Elbert et al [] focused on effectiveness and cost-effectiveness for somatic diseases and Hubley et al [], on psychiatric diseases. Bashshur et al [] examined 3 tracer diseases (heart failure, stroke, and COPD), which, when treated using telemedicine approaches, showed several markers of improvement, such as reduced hospital admissions and readmissions, length of hospital stay, and emergency department visits. Fierson et al [] reviewed the currently available literature on telemedicine-based remote digital fundus imaging evaluations for retinopathy of prematurity and outlined pertinent practical and chance management considerations.
Kvedar et al [] presented a model of care to make telemedicine an important part of the US health care organization. He reported that intendance processes in the United States are insufficient to address the mismatch in supply and need of health care providers []. This review presented connected health every bit a new care model to meliorate patient care with telemedicine and telehealth. Kidholm et al [], after synthesizing testify from a stakeholders meeting, presented a framework for the assessment of telemedicine with seven important domains: (1) health problem and description of the application, (2) safety, (3) clinical effectiveness, (iv) patient perspectives, (5) economical aspects, (6) organizational aspects, and (7) sociocultural, ethical, and legal aspects. A summary of these publications is provided in .
| Author (year) | Study design | Theme | Affliction | Lesson learned |
| Wootton (2012) []a | Review | Evidence synthesis | Chronic diseases | This study presents an evidence synthesis report on 141 RCTsb pertaining to asthma, COPDc, diabetes, heart failure, and hypertension. In that location was strong show of publication bias, with 108 RCTs reporting positive results and nigh none reporting harm. |
| Wade et al (2010) [] | Systematic review | Economic analysis | —d | Commitment of health services past existent-time video advice was cost-effective for home intendance and access to on-call hospital specialists, showed mixed results for rural service delivery, and was not toll-constructive for local delivery of services between hospitals and primary care. |
| Chaudhry et al (2010) []a | Clinical trial | Effectiveness | Center failure | Telemonitoring did not improve outcomes among patients hospitalized for heart failure. |
| Ekeland et al (2010) []a | Systematic review of systematic reviews | Effectiveness | — | Out of eighty included systematic reviews, 21 showed that telemedicine was effective, and 18 reported that testify regarding telemedicine was limited and inconsistent. |
| Kvedar et al (2014) []a | Literature review | Model of health care | — | Care processes in the United states of america are insufficient to accost the mismatch in supply and demand of health care providers. This review presented connected wellness as a new care model to ameliorate patient care with telemedicine and telehealth. |
| Elbert et al (2014) [] | Systematic review of systematic reviews | Effectiveness and cost-effectiveness | Somatic diseases | Out of 31 eligible reviews, 7 found eHealth to exist clinically constructive and cost-effective and thirteen establish it to exist promising, while the rest institute the evidence to be express or inconsistent. |
| Bashshur et al (2014) []a | Systematic review | General review | Chronic diseases: centre failure, stroke, and COPD | The 3 diseases, when treated using telemedicine approaches, showed several improvements, such as reduced hospital admissions and readmissions, length of hospital stay, and emergency department visits. |
| Flodgren et al (2015) []a | Systematic review and meta-assay | Effectiveness | Cardiovascular disease, diabetes, respiratory conditions, mental health or substance abuse conditions, atmospheric condition requiring a specialist consultation, comorbidities, urogenital conditions, neurological injuries and weather, gastrointestinal weather condition, neonatal conditions requiring specialist care, solid-organ transplantation, and cancer | There was high- to moderate-certainty evidence that there was no significant difference betwixt telemedicine and usual wellness care in improving all-crusade mortality and admissions to the hospital. There was some evidence of improved quality of life, lower HbA1c e amongst patients with diabetes, and decreased LDLf and blood pressure. Participants with different mental health and substance abuse problems reported no differences in the result of therapy delivered over videoconferencing compared with face-to-face up commitment. |
| Kidholm et al (2012) []a | Recommendations based on workshops with users and stakeholders of telemedicine, initiated by European Commission | Framework for cess of telemedicine | — | There are 7 domains in MASTg: (one) health problem and description of the application, (2) condom, (3) clinical effectiveness, (four) patient perspectives, (5) economic aspects, (6) organizational aspects, and (seven) sociocultural, ethical, and legal aspects. |
| Schwamm et al (2009) []a | Run into Table 2 | See Table 2 | Come across Table ii | See Table two |
| Lilly et al (2011) []a | See Table 2 | Encounter Table ii | Come across Tabular array 2 | See Table 2 |
| Hilty et al (2013) []a | Review | Effectiveness | Mental wellness | This review reported that tele–mental health interventions are effective and improve access to care. More than research is required on service models and ethical and cross-cultural aspects of tele–mental health. |
| Dharmar et al (2013) []a | Retrospective | Quality improvement | Pediatric critical intendance | Telemedicine consultations were associated with higher physician-rated quality of care and parent satisfaction. |
| Sanders et al (2012) [] | Qualitative | Evaluation and barriers to adoption | Telehealth in general | This qualitative investigation examined barriers to participation and adoption of telehealth among people who withdrew from a Britain-based clinical trial on telemedicine. |
| Fierson et al (2015) [] | Review | Evaluation for retinopathy of prematurity | Retinopathy of prematurity | This report reviewed the currently bachelor literature on RDFI-TMh evaluations for retinopathy of prematurity and outlined pertinent practical and run a risk management considerations. |
| Ashwood et al (2017) [] | Retrospective | Effectiveness and cost-effectiveness | — | Direct-to-consumer telehealth may increase access to care but does not decrease spending; 12% of direct-to-consumer telehealth visits replaced visits to other providers, and 88% represented new use. Net annual spending on acute respiratory illness increased $45 per telehealth user. |
| Hubley et al (2016) [] | Systematic review | Effectiveness | Psychiatric diseases | A large testify base supported telepsychiatry as a delivery method for mental health services. Future studies will inform optimal approaches to implementing and sustaining telepsychiatry services. |
aMajestic nodes in representing seminal work in the surface area of telemedicine.
bRCTs: randomized controlled trials.
cCOPD: chronic obstructive pulmonary affliction.
dNot available.
eHbA1c: glycated hemoglobin.
fLDL: depression-density lipoprotein.
thousandMAST: model for assessment of telemedicine.
hRDFI-TM: telemedicine-based remote digital fundus imaging.
Word
Summary
This scientometric assay presents an overview of scholarly work in the field of telemedicine in the concluding 10 years. It shows the transition of scholarly work in this field from teleradiology in the previous decade to mental health, stroke, and critical care medicine. Barriers and facilitators to successful implementation of telemedicine were too seen as an important area of research in telemedicine. Collaborative networks between regions and institutions revealed collaborative links between key global institutions and LMICs, showing a transfer of technology and expertise to disparate regions. Among the LMICs, Red china and Republic of india are emerging as large players in telemedicine.
General Trends and Transcontinental Collaborations
Our analysis revealed a steadily increasing publication output and citation activity in the field of telemedicine, which is in consonance with previous literature [,,,,]. In terms of regional output, a bibliometric assessment of literature in telemedicine from 1980 to 2013 showed that the superlative v countries in terms of publication output were the United States, the Uk, Frg, Canada, and Australia, while China ranked tenth []. However, we opine that the axis or influence of a particular entity in their collaborative networks and the book of innovative work may be amend indicators of progress in a field. In this vein, England, France, Belgium, Portugal, the People'south Commonwealth of China, and Greece appeared to hold significant influence worldwide. Similarly, almost all of the top institutions with regard to publication output were from the Usa, which reflects previous literature [,,,,]. Withal, simply i of the U.s.a.–based universities was found to exist key in its domain. Top institutions were Columbia Academy, Academy of Queensland, University of Toronto, and Karolinska Plant.
Several of the superlative institutions were involved in collaborations with institutions from LMICs, indicating transfer of technology and expertise. This is an important endeavor, as studying the effectiveness and uptake of telemedicine may decrease disparities in these regions. Portugal, for instance, provides a good case written report to examine collaborative networks between high-income and low-income countries. A transcultural pediatric telecardiology service has been established in several Portuguese-speaking African countries in collaboration with Portugal-based universities []. This program has been highly successful. For case, in Angola alone, it has performed 32,685 outpatient teleconsultations (1998 to 2016), saving health system costs []. Another important endeavor includes echocardiography services through a telecardiology initiative being provided in Tanzania, Republic of malaŵi, Mali, and Mozambique with a telereporting center in Italy []. On Oct 26, 2017, another impetus for telemedicine research and implementation was provided by a resolution that created the Comunidade dos Países de Língua Portuguesa's Permanent Working Group on Telemedicine and Telehealth during the 4th Wellness Ministers Coming together of the Portuguese-Speaking Countries in Brasília [].
Transition of Enquiry Themes
We noticed a transition in inquiry themes in telemedicine during these periods. For case, the WHO reports cited teleradiology services as being near prevalent worldwide. In line with this, Armfield et al [], using text-mining approaches, reported that during the early period of telemedicine inquiry from 1970 to 1995, teleradiology and telepathology were the near dominant fields, as well equally the start fields to adopt telemedicine. In dissimilarity, inquiry trends in a more recent period (2009 to 2013) focused on cost-effectiveness, and the clinical and discipline-specific terms "diabetic" and "stroke" emerged in this period. Our analyses revealed that these themes progressed into the established fields of telecardiology, telestroke, and tele-ICU. Moreover, we likewise saw a rise in price-effectiveness as well as implementation and feasibility inquiry, which are very of import aspects in the uptake of telemedicine. All the influential studies in our analyses pertained to these themes.
Research Gaps and Recommendations for Time to come Work
Despite a continuous rise in scholarly activity in telemedicine, we noticed several gaps in the literature. For instance, all the primary and secondary research central to telemedicine was conducted in the context of loftier-income countries, including the evidence synthesis approaches pertaining to implementation aspects of telemedicine. In addition, patient confidentiality and ethical perspectives on the apply of telemedicine were nonexistent in our analysis. Almost of the telemedicine research in LMICs was driven in collaboration with loftier-income countries. There is a huge gap in needs-based analysis, eHealth literacy, and inclusion of Indigenous end consumers and stakeholders in the blueprint of telemedicine platforms in LMICs.
In that location were also no research clusters on improving eHealth literacy, especially in the context of apply of telemedicine in LMICs. The lack of strengths, weaknesses, opportunities, and threats analyses, particularly in the evaluation of eHealth literacy amid physicians, is a big cistron in the failure of telemedicine. This was a major contributory cistron in the failure of the Réseau en Afrique Francophone pour la Télémédecine (RAFT) telemedicine software platform in Angola, which enjoyed commitment from the Ministry of Health and local stakeholders only was not taken upwardly past the participating physicians [].
Telemedicine financing is a critical attribute for sustainability and most often not covered in studies. The development of telemedicine on a global scale volition crave more sophisticated business concern models. Additionally, telemedicine skills development is very seldom provided past medical schools.
Telemedicine is yet in its infancy in LMICs, and there is a lack of clarity in several important aspects, such as the evolution and adoption of ethical standards, handling protocols, and guidelines. Medical informaticians should liaise with wellness care centers, physicians, and medical ethicists to develop software promoting an ethos of confidentiality, privacy, and security during the sharing of sensitive data.
Conclusion
The findings in this investigation suggest a rapid evolution in the field of telemedicine, albeit prior to the COVID-19 pandemic. Nosotros expect that the research mural and implementation of telemedicine infrastructure may see exponential progress during and after the COVID-19 period. This is also echoed in the recent report by the American Medical Clan, which predicts that "after COVID-19, $250 billion in intendance could shift to telehealth, boosting research and infrastructural development" [].
Conflicts of Involvement
None declared.
Abbreviations
| COPD: chronic obstructive pulmonary disease |
| ICT: information and communication engineering |
| ICU: intensive care unit |
| LLR: log likelihood ratio |
| LMIC: depression- and center-income country |
| mHealth: mobile health |
| PTSD: posttraumatic stress disorder |
| RAFT: Réseau en Afrique Francophone pour la Télémédecine |
| TF-IDF: term frequency-changed document frequency |
| WHO: World Health Organization |
| WOS: Spider web of Scientific discipline |
Edited by G Eysenbach; submitted 22.03.twenty; peer-reviewed past Northward Piland, DM Kulhandjian; comments to author 28.06.xx; accustomed 26.07.20; published 02.10.20
Copyright©Ahmed Waqas, Soo Huat Teoh, Luís Velez Lapão, Luiz Ary Messina, Jorge César Correia. Originally published in the Periodical of Medical Internet Inquiry (http://www.jmir.org), 02.10.2020.
This is an open-admission article distributed nether the terms of the Creative Eatables Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted utilize, distribution, and reproduction in whatever medium, provided the original work, kickoff published in the Journal of Medical Internet Enquiry, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license data must exist included.
Source: https://www.jmir.org/2020/10/e18835/
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