Background: Telehealth is the delivery of health care at a distance, using information and communication technology. The major rationales for its introduction have been to decrease costs, improve efficiency and increase access in health care delivery. This systematic review assesses the economic value of one type of telehealth delivery - synchronous or real time video communication - rather than examining a heterogeneous range of delivery modes as has been the case with previous reviews in this area.
Methods: A systematic search was undertaken for economic analyses of the clinical use of telehealth, ending in June 2009. Studies with patient outcome data and a non-telehealth comparator were included. Cost analyses, noncomparative studies and those where patient satisfaction was the only health outcome were excluded.
Results: 36 articles met the inclusion criteria. 22(61%) of the studies found telehealth to be less costly than the non-telehealth alternative, 11(31%) found greater costs and 3 (9%) gave the same or mixed results. 23 of the studies took the perspective of the health services, 12 were societal, and one was from the patient perspective. In three studies of telehealth to rural areas, the health services paid more for telehealth, but due to savings in patient travel, the societal perspective demonstrated cost savings. In regard to health outcomes, 12 (33%) of studies found improved health outcomes, 21 (58%) found outcomes were not significantly different, 2(6%) found that telehealth was less effective, and 1 (3%) found outcomes differed according to patient group. The organisational model of care was more important in determining the value of the service than the clinical discipline, the type of technology, or the date of the study.
Conclusion: Delivery of health services by real time video communication was cost-effective for home care and access to on-call hospital specialists, showed mixed results for rural service delivery, and was not cost-effective for local delivery of services between hospitals and primary care.
Telehealth is the delivery of health care services at a distance, using information and communication technology (ICT). Telehealth became a separate field of study from the 1970’s, and innovation increased from the 1990’s, due to the development of new technologies such as cellular phones and the internet. The field was originally known as telemedicine, but was later broadened to telehealth, although these terms continue to be used interchangeably. It is a subset of e-health, which encompasses all uses of ICT in health, including electronic records and decision support systems, however telehealth is particularly characterised by the geographical separation of patient and provider. Tulu categorises telehealth according to its purpose, such as clinical, educational or administrative; its healthcare discipline area; the environmental setting; the type of communication infrastructure used; and the delivery modality. Telehealth applications are very diverse, ranging from home care for chronic diseases, to remote primary care and subspecialist services such as paediatric cardiology. Telehealth can be delivered synchronously, also known as real-time, where the participants interact with each other simultaneously, and asynchronously, also known as store-and-forward, in which information such as X-rays or photographs are collected, transmitted, and then utilised at a later time.