Evidence Report/Technology Assessment 

Number 131 

Telemedicine for the Medicare Population: Update 

Prepared for: 

Agency for Healthcare Research and Quality 

U.S. Department of Health and Human Services 

540 Gaither Road 

Rockville, MD 20850 

www.ahrq.gov 

Contract No. 290-02-0024 

Prepared by: 

Oregon Evidence-based Practice Center, Portland, OR 

Investigators 

William R. Hersh, MD, Principal Investigator

David H. Hickam, MD, MPH 

Susan M. Severance, MPH 

Tracy L. Dana, MLS 

Kathryn Pyle Krages, AMLS, MA 

Mark Helfand, MD, MS, EPC Director 

AHRQ Publication No. 06-E007 

February 2006 
This report is based on research conducted by the Oregon Evidence-based Practice 

Center (EPC), under contract to the Agency for Healthcare Research and Quality 

(AHRQ), Rockville, MD (Contract No. 290-02-0024). The findings and conclusions in 

this document are those of the author(s), who are responsible for its content, and do not 

necessarily represent the views of AHRQ. No statement in this report should be 

construed as an official position of AHRQ or of the U.S. Department of Health and 

Human Services. 

The information in this report is intended to help clinicians, employers, policymakers, 

and others make informed decisions about the provision of health care services. This 

report is intended as a reference and not as a substitute for clinical judgment. 

This report may be used, in whole or in part, as the basis for the development of clinical 

practice guidelines and other quality enhancement tools, or as a basis for reimbursement 

and coverage policies. AHRQ or U.S. Department of Health and Human Services 

endorsement of such derivative products may not be stated or implied. 
ii

This document is in the public domain and may be used and reprinted without permission except 

those copyrighted materials noted for which further reproduction is prohibited without the 

specific permission of copyright holders. 

Suggested Citation: 

Hersh WR, Hickam DH, Severance SM, Dana TL, Krages KP, Helfand M. Telemedicine for the 

Medicare Population: Update. Evidence Report/Technology Assessment No. 131 (Prepared by 

the Oregon Evidence-based Practice Center under Contract No. 290-02-0024.) AHRQ 

Publication No. 06-E007. Rockville, MD: Agency for Healthcare Research and Quality. 

February 2006. 
iii

Preface 

 The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-Based 

Practice Centers (EPCs), sponsors the development of evidence reports and technology 

assessments to assist public- and private-sector organizations in their efforts to improve the 

quality of health care in the United States. This report was requested and funded by the Centers 

for Medicare & Medicaid Services. The reports and assessments provide organizations with 

comprehensive, science-based information on common, costly medical conditions and new 

health care technologies. The EPCs systematically review the relevant scientific literature on 

topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to 

developing their reports and assessments. 

 To bring the broadest range of experts into the development of evidence reports and health 

technology assessments, AHRQ encourages the EPCs to form partnerships and enter into 

collaborations with other medical and research organizations. The EPCs work with these partner 

organizations to ensure that the evidence reports and technology assessments they produce will 

become building blocks for health care quality improvement projects throughout the Nation. The 

reports undergo peer review prior to their release. 

 AHRQ expects that the EPC evidence reports and technology assessments will inform 

individual health plans, providers, and purchasers as well as the health care system as a whole by 

providing important information to help improve health care quality. 

 We welcome comments on this evidence report. They may be sent by mail to the Task Order 

Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, 

Rockville, MD 20850, or by e-mail to epc@ahrq.gov.

Carolyn M. Clancy, M.D. 

Director 

Agency for Healthcare Research and Quality 

Mark B. McClellan, M.D., Ph.D. 

Administrator 

Centers for Medicare & Medicaid Services 

 

Jean Slutsky, P.A., M.S.P.H. 

Director, Center for Outcomes and Evidence 

Agency for Healthcare Research and Quality 

Beth A. Collins Sharp, R.N., Ph.D. 

Acting Director, EPC Program 

Agency for Healthcare Research and Quality 

Martin Erlichman, M.S. 

EPC Program Task Order Officer 

Agency for Healthcare Research and Quality 
iv

Acknowledgments

 

Valuable assistance for this project was provided by external peer reviewers, and the research 

team would like to acknowledge their helpful contributions to the project. A listing of those 

individuals appears in Appendix D. We also acknowledge the efforts of the Evidence-based 

Practice Center support staff, specifically Andrew Hamilton, MLS, MS. Our Task Order Officer 

from the Agency for Healthcare Research and Quality, Martin Erlichman, MS, also provided 

invaluable assistance and guidance in the preparation of this report. 
v

Structured Abstract 

Context. Telemedicine services are increasingly utilized by patients, clinicians, and 

institutions. Although private and Federal insurers are covering some telemedicine 

services, the rationale for these coverage decisions is not always evidence-based. 

Objectives. The goal of this report was to assess the peer-reviewed literature for 

telemedicine services that substitute for face-to-face medical diagnosis and treatment that 

may apply to the Medicare population. We focused on three distinct areas: store-andforward, home-based, and office/hospital-based services. We also sought to identify 

what progress had been made in expanding the evidence base since the publication of our 

initial report in 2001 (AHRQ Publication No. 01-E012.)

Data Sources. Ovid MEDLINE®, reference lists of included studies, and non-indexed 

materials recommended by telemedicine experts. 

Study Selection. Included studies had to be relevant to at least one of the three study 

areas, address at least one key question, and contain reported results. We excluded 

articles that did not study the Medicare population (e.g., children and pregnant adults) or 

used a service that does not require face-to-face encounters (e.g., radiology or pathology 

diagnosis).

Data Extraction. Our literature searches initially identified 4,083 citations. Using a 

dual-review process, 597 of these were judged to be potentially relevant to our study at 

the title/abstract level. Following a full-text review, 97 studies were identified that met 

our inclusion criteria and were subsequently included in the report’s evidence tables.

Data Synthesis. Store-and-forward services have been studied in many specialties, the 

most prominent being dermatology, wound care, and ophthalmology. The evidence for 

their efficacy is mixed, and in most areas, there are not corresponding studies on 

outcomes or improved access to care. 

Several limited studies showed the benefits of home-based telemedicine interventions 

in chronic diseases. These interventions appear to enhance communication with health 

care providers and provide closer monitoring of general health, but the studies of these 

techniques were conducted in settings that required additional resources and dedicated 

staff. 

Studies of office/hospital-based telemedicine suggest that telemedicine is most 

effective for verbal interactions, e.g., videoconferencing for diagnosis and treatment in 

specialties like neurology and psychiatry. 

Conclusions. There are still significant gaps in the evidence base between where 

telemedicine is used and where its use is supported by high-quality evidence. Further 

well-designed and targeted research that provides high-quality data will provide a strong 

contribution to understanding how best to deploy technological resources in health care. 

vii

Contents 

 

Executive Summary.................................................................................................................. 1 

Evidence Report...................................................................................................................... 9 

 

Chapter 1. Introduction ............................................................................................................ 11 

 Goal of the Report............................................................................................................... 11 

 Definitions........................................................................................................................... 11 

 Telemedicine Study Areas .................................................................................................. 12 

 Other Telemedicine Research Summaries.......................................................................... 13 

Chapter 2. Methods.................................................................................................................. 15 

 Analytic Framework and Key Questions about the Efficacy of Telemedicine Services.... 15 

 Literature Search Strategy................................................................................................... 16 

 Selection of Abstracts and Full-text Articles...................................................................... 17 

 Data Abstraction ................................................................................................................. 19 

 Assessment of Study Quality.............................................................................................. 19 

 Data Synthesis..................................................................................................................... 21 

 Peer Review Process........................................................................................................... 22 

 

Chapter 3. Results .....................................................................................................................23 

 Overview of Peer-reviewed Studies.................................................................................... 23 

 Store-and-Forward Telemedicine ....................................................................................... 24 

 Home-Based Telemedicine................................................................................................. 27 

 Office/Hospital-Based Telemedicine.................................................................................. 29 

 Studies of Telemedicine in Non-Medicare Populations ..................................................... 31 

Chapter 4. Discussion ............................................................................................................... 33 

 Evidence about Efficacy ..................................................................................................... 33

 Future Research .................................................................................................................. 36

 Conclusion .......................................................................................................................... 36 

References and Included Studies .............................................................................................. 37

Figures 

 

Figure 1. Analytic framework................................................................................................... 15

Figure 2. Results of literature search and abstract review ........................................................ 18

Tables 

 

Table 1. Inclusion/exclusion criteria......................................................................................... 19 

Table 2. Inter-rater reliability.................................................................................................... 19 

Table 3. Classification of evidence for studies of clinical outcomes........................................ 20 

Table 4. Classification of evidence for diagnostic and management decisions........................ 20 
viii

Table 5. Classification of strength of evidence for studies of access to care............................ 21 

Table 6. Classification of direction of effect ............................................................................ 21

Table 7. Summary of included studies...................................................................................... 23 

Table 8. Summary of studies by key questions and results ...................................................... 23

Table 9. Summary of studies of store-and-forward telemedicine for diagnosis and/or 

 management decisions ........................................................................................................ 25

Table 10. Summary of studies of the effects of store-and-forward telemedicine on 

 access to care ................................................................................................................... 26

Table 11. Summary of studies of home-based telemedicine for clinical outcomes.................. 27

Table 12. Summary of studies of office/hospital-based telemedicine for diagnosis and/or 

 management decisions........................................................................................................ 29 

Table 13. Summary of studies of office/hospital-based telemedicine for clinical outcomes...30 

Table 14. Summary of studies of the effect of office/hospital-based telemedicine on access 

 to care.............................................................................................................................. 30

Appendixes 

Appendix A: Exact Search Strings 

Appendix B: Sample Data Abstraction Forms 

Appendix C: Evidence Tables and List of Included Studies 

Appendix D: List of Excluded Studies 

Appendix E: Peer Reviewers 

Appendixes and Evidence Tables for this report are provided electronically at 

http://www.ahrq.gov/downloads/pub/evidence/pdf/telemedup/telemedup.pdf. 
1

Executive Summary 

Overview 

 Telemedicine is the use of telecommunications technology for medical diagnostic, 

monitoring, and therapeutic purposes where distance and/or time separates the patient and 

health care provider. Both federal and private health insurers are now covering some 

telemedicine services, despite the fact that the benefits and costs of providing many of 

these services have not been well studied. 

 This report assesses the peer-reviewed literature of specific telemedicine study areas, 

with a focus on those that substitute for face-to-face medical diagnosis and treatment of 

the Medicare population. Thus, this report targets face-to-face clinical specialties (as 

opposed to radiology and pathology) and the Medicare population. It does not evaluate 

studies examining populations that usually are not covered by Medicare, such as children 

and pregnant women. The report identifies health care services that could be provided 

using telemedicine and describes existing programs in three categories of telemedicine: 

store-and-forward, home-based and office/hospital-based services. 

Introduction 

 This evidence report provides an update on the state of telemedicine, following the 

2001 publication of Telemedicine for the Medicare Population.

1

 It identifies whether 

there has been significant progress in the number and types of telemedicine studies being 

conducted. More specifically, we searched for well-designed studies that evaluated 

telemedicine services in three technological categories described below. 

Store-and-forward Telemedicine

In store-and-forward telemedicine, clinical data are collected, stored, and then 

forwarded to be interpreted later. A store-and-forward system eliminates the need for the 

patient and the clinician to be available at either the same time or place. The following 

key questions were addressed for store-and-forward telemedicine services in Medicareeligible patient populations. 

1. Does store-and-forward telemedicine result in comparable diagnostic decisions 

and recommendations for clinical management? 

2. Does store-and-forward telemedicine result in comparable health outcomes? 

3. Does the availability of store-and-forward telemedicine services improve access 

to care? 

Home-based Telemedicine 

Home-based telemedicine services enable physicians and other health care providers 

to monitor physiologic measurements, test results, images, and sounds, usually collected 
2

in a patient’s residence or a care facility. The use of home-based telemedicine services in 

Medicare-eligible patient populations was examined, asking the following questions 

relative to conventional care using face-to-face encounters. 

1. Does home-based telemedicine result in comparable diagnostic decisions and 

recommendations for management? 

2. Does the use of home-based telemedicine result in comparable health 

outcomes? 

3. Does the use of home-based telemedicine improve access to care? 

Office/Hospital-based Telemedicine 

Office/hospital-based telemedicine services are real-time clinician-patient interactions 

that substitute for face-to-face encounters between a patient and a physician or other 

health care provider. The use of office/hospital-based telemedicine was evaluated 

relative to face-to-face encounters on the basis of the following questions. 

1. Does office/hospital-based telemedicine result in comparable diagnosis and 

appropriateness of recommendations for management? 

2. Does office/hospital-based telemedicine result in comparable health outcomes? 

3. Does the availability of office/hospital-based telemedicine improve access to 

care? 

Methods 

 The Oregon Evidence-based Practice Center (EPC) team that developed this report 

sought to identify peer-reviewed literature in the three study areas. We searched the 

peer-reviewed literature using the Ovid MEDLINE® electronic bibliographic database. 

We also searched through telemedicine reports and compilations, including their 

reference lists. 

 The inclusion criteria for the evidence report update 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. Exclusion criteria for the 

evidence report update were that the study did not address a key question, lacked reported 

results, had a study population that was not relevant to the Medicare population (i.e., 

children and pregnant adults) or substituted for a service that did not historically require 

face-to-face encounters (e.g., diagnostic services in radiology or pathology). 

 We categorized the included articles by the key question(s) they addressed. The 

included studies for each study area and key question were critically appraised to 

determine the strengths and limitations of the most important studies following a detailed 

rationale for the appraisal of study characteristics related to quality. 

 For each study area, we constructed an evidence table summarizing the strength of the 

evidence for each key question. We then constructed summary tables for clinical 

specialties or domains. For studies of diagnosis and management decisions, we explicitly 

noted whether studies assessed concordance (without a diagnostic gold standard) or 
3

accuracy (with a gold standard) of the telemedicine system when compared to 

conventional care. 

Results 

General Observations 

Following review of the abstracts of all studies retrieved in the literature search, a 

total of 597 citations were determined potentially to have evidence for the efficacy of one 

of the three study areas. The full text of these 597 articles was reviewed. After exclusion 

criteria were applied, there were 97 articles included in evidence tables. Of these, 35 

articles assessed store-and-forward telemedicine services, 27 articles evaluated homebased services, and 38 articles assessed office/hospital-based services. Some studies 

assessed more than one telemedicine study area. 

Specific Results 

Individual studies were assessed for evidence based on criteria applicable to the study 

question. Studies were too heterogeneous to undertake any quantitative aggregate 

analyses such as meta-analysis. 

Store-and-forward telemedicine. Similar to our original evidence report, the studies 

we found of store-and-forward telemedicine only assessed diagnosis or management 

decisions and not outcomes. As we also found in the original report, some aspects of the 

telemedicine systems used in home and office-hospital settings made use of store-andforward techniques, but in the context of larger and/or interactive interventions. 

1. Does store-and-forward telemedicine result in comparable diagnostic 

decisions and recommendations for clinical management? 

Similar to the original report, the largest number of studies came from the 

specialty of dermatology. The most commonly assessed aspect of 

teledermatology was interobserver concordance. The range of concordance 

varied widely, from 41 percent to 87 percent for complete agreement to 51 

percent to 96 percent for disease-category agreement. All of these studies were 

limited by the lack of measurement of concordance among more than one face-toface examiner. Concordance studies assessing management decisions typically 

looked at decision to biopsy. While one study found complete agreement, others 

found lesser concordance. The studies of diagnostic accuracy typically compared 

the telemedicine diagnosis to some sort of gold standard, often a biopsy of a 

pigmented lesion. In these studies, telemedicine generally was nearly as good as 

face-to-face in correctness of diagnosis. The second most frequently studied 

clinical area was wound care. These studies demonstrated that some 

characteristics of skin wounds and ulcerations could be assessed effectively using 

store-and-forward telemedicine. However, most of these studies had small 

numbers of patients and very small numbers of clinicians, raising statistical power 
4

issues. Five studies provide data on store-and-forward applications in 

ophthalmology. Four of these studies show that a high accuracy of diagnosing 

diabetic retinopathy could be obtained. Other specialties studied included 

gynecology and gastroenterology. 

2. Does store-and-forward telemedicine result in comparable health outcomes? 

Similar to the previous report, there were no studies that assessed health outcomes 

using store-and-forward telemedicine interventions. This is problematic for 

assessing the overall benefit of store-and-forward telemedicine, since the 

outcomes from its use for diagnosis and management decisions are unclear. 

3. Does the availability of store-and-forward telemedicine services improve 

access to care? 

When store-and-forward telemedicine systems have been evaluated as a method 

for performing specialty consultations of patients followed by general 

practitioners or primary care clinicians, the systems have had only a small impact 

on reducing the need for subsequent face-to-face clinical evaluations by 

specialists. While these systems can aid in the triage of patients referred for 

consultation, they have not been shown conclusively either to improve access to 

care or to have a negative influence on access to care. Five studies reported 

evidence on the effect of store-and-forward techniques upon access to care. The 

methodologic quality of these studies generally was low. 

 

Home-based telemedicine. Home-based telemedicine is most commonly used for 

management of chronic diseases or specific conditions, such as heart disease, diabetes 

mellitus, and rehabilitation. Some studies show telemedicine applied in this setting can 

be efficacious, although many are limited by small sample sizes, inadequate length of 

follow-up, and inconclusive results.

1. Does home-based telemedicine result in comparable diagnostic decisions and 

recommendations for management? 

Two studies assessed diagnostic capabilities in the home in the areas of 

congestive heart failure assessment and pulmonary function monitoring. These 

studies found various levels of agreement and disagreement depending on the 

specific observation. 

2. Does home-based telemedicine result in comparable health outcomes? 

A variety of published studies have assessed chronic diseases afflicting patients in 

the Medicare population, such as congestive heart failure, diabetes mellitus, 

coronary artery disease, and hypertension. Unfortunately, the studies are very 

heterogeneous, and their limitations prevent broad conclusions. Interventions 

showing multi-faceted interventions demonstrate more benefit than single 
5

interventions, such as monitoring of blood sugar or blood pressure. However, in 

most studies, it is not possible to assess whether improved outcomes are due to 

the increased level of care provided by dedicated clinical staff versus the 

technology intervention. 

3. Does the use of home-based telemedicine improve access to care? 

No studies were identified that examined the effect of home-based telemedicine services 

on access to care. 

Office/hospital-based telemedicine. A variety of studies were found that assessed 

office/hospital-based telemedicine. The largest number of studies assessed diagnosis and 

management decisions, and these studies examined a broad range of medical specialties. 

There were, however, very few studies of high methodologic quality. 

1. Does office/hospital-based telemedicine services result in comparable 

diagnosis and appropriateness of recommendations for management? 

For diagnosis and management decisions, the most frequently studied specialty 

was ophthalmology. As with store-and-forward studies, some aspects of 

ophthalmologic evaluation were amenable to interactive telemedicine, while 

others were not. Other frequently studied specialties included neurology and 

psychiatry, which demonstrated that some diagnostic assessments can be 

successfully administered via telemedicine. 

2. Does office/hospital-based telemedicine result in comparable health 

outcomes? 

Studies of outcomes also showed that for most of the clinical specialties assessed, 

outcomes with telemedicine interventions are comparable to those using 

conventional clinical evaluations. However, most of these studies are limited by 

small sample sizes and/or other problems. None of these studies attempted to 

measure their statistical power to avoid type-2 (beta) errors. 

3. Does the availability of office/hospital-based telemedicine improve access to 

care?

Studies having relatively weak methodologies suggest that office/hospital-based 

telemedicine can improve access to care for patients in rural locations in medical 

applications in which patient evaluations can be performed using standard 

teleconferencing equipment. 

Discussion 

This update on evidence about the efficacy of telemedicine for the Medicare 

population covered published peer-reviewed literature for the five years between 2000 
6

and 2004. Similar to the findings of our original report a half-decade ago, there are still 

serious gaps in the evidence base for telemedicine. While this situation is hardly unique 

to telemedicine, having a solid evidence base is essential given that there is increased 

advocacy for health care payers, especially Medicare, to provide coverage for its use. 

The best evidence for the effectiveness of telemedicine is in medical specialties for 

which verbal interactions are a key component of the patient assessment, such as 

psychiatry and neurology. Various psychiatric and neurological assessments can be 

administered effectively via interactive videoconferencing. Likewise, treatments 

administered in these specialties via telemedicine appear to achieve comparability with 

face-to-face care. 

Our systematic review also identified several studies, a few of them of high 

methodologic quality, showing benefits of home-based telemedicine interventions in 

chronic diseases. These systems appear to enhance communication with health care 

providers and provide closer monitoring of general health, but the studies of these 

techniques were conducted in settings that required additional resources and dedicated 

staff. With ongoing improvements in telecommunications technology, particularly 

broadband connections to the home, further research, including larger clinical trials, will 

likely be informative. 

The specialty with the largest number of studies is dermatology, and most studies of 

teledermatology have evaluated store-and-forward techniques. The body of evidence 

summarized in this report is consistent with the findings of the earlier report. There 

continues to be highly variable rates of interobserver and intraobserver agreement in 

diagnoses. This issue can only be resolved by high-quality studies that compare not only 

the concordance of telemedicine versus face-to-face diagnosis, but also the concordance 

of face-to-face versus face-to-face diagnosis in the same situation. 

Of course, rates of concordance in a vacuum, i.e., without a clinical context of how 

the patient fared, are also limited from an evidence standpoint. What we ultimately need 

to know is the patient outcome. In other words, did the teledermatology encounter at 

least provide comparable care for the patient? A corollary question that must be 

answered is whether teledermatology resulted in harm from any missed diagnoses or 

other consequences of the telemedicine encounter. These questions can only be answered 

in studies of clinical outcomes, none of which were identified in this report. In general, 

advocacy for an expanded role for teledermatology will require further studies that 

examine rates of missed diagnoses, incorrect treatments, and when the technology is 

insufficient to avoid in-person encounters. 

Other widely studied domains include ophthalmology and wound care. 

Teleophthalmology appears to result in high rates of diagnostic concordance and 

accuracy, but only for some eye conditions. It appears to be particularly efficacious in 

assessment of diabetic retinopathy. Studies of wound care show potential, but are limited 

by small sample sizes, use of only one assessor, and lacking comparison to other inperson examiners when assessing concordance. 

There may be situations when the use of telemedicine is warranted even if the 

evidence is lacking. For example, there may be situations when care would be otherwise 

impossible to deliver except via telemedicine. This could include remote rural areas or 

other locations where medical care is not available locally and the patient is for whatever 

reason unable to travel to a setting where it can be obtained. However, even in these 
7

instances it is important to understand the efficacy of telemedicine so that any clinical 

shortcomings can be anticipated. 

The present evidence base provides guidance on the clinical areas in which future 

research is most likely to be useful. It now is clear that continued small or 

methodologically weak studies are unlikely to add to the evidence base for telemedicine. 

In teledermatology, larger and more comprehensive analyses that assess key patient 

outcomes are needed. Likewise, there is a need for similar studies of clinical outcomes 

using office/hospital-based telemedicine in fields such as psychiatry and neurology. 

Well-designed randomized controlled trials will likely provide valuable information on 

the potential of these clinical applications. Longitudinal observational studies and 

demonstration projects also will be useful. Studies of home-based telemedicine should 

carefully address the independent contributions of technology and human resources in the 

complex delivery models for patients with chronic diseases. 
1

Evidence Report

11

Chapter 1. Introduction 

Goal of the Report 

The goal of this report is to present an overview of the scientific evidence on 

diagnosis and management decisions, clinical outcomes, and access to services through 

the use of three categories of telemedicine services: store-and-forward, home-based, and 

office/hospital-based. The report is intended to provide an update on the evidence for the 

efficacy of telemedicine services in the Medicare population. Consequently, the scope of 

this report is limited to telemedicine programs and clinical settings that have been used 

for, or are likely to be applied to, Medicare beneficiaries. 

This report provides an update on the state of telemedicine, following the 2001 

publication of Telemedicine for the Medicare Population (AHRQ Publication No. 01-

E012).1 Our initial report found that while telemedicine was in widespread use, the 

evidence of efficacy for those uses was lacking. But even more problematic was the 

quality of evaluative studies. Many studies were performed using poor methodologies 

and small sample sizes. Indeed, our major conclusion was not that telemedicine was not 

efficacious, but rather that the quality of the studies evaluating it prevented one from 

making that determination at all. Another goal of the current report is to determine 

whether there has been progress in the number and quality of telemedicine studies that 

have been conducted since then. 

We note that this report only presents a view of telemedicine from the standpoint of 

the peer-reviewed medical literature. This does not represent the sum of all experience 

with telemedicine. Indeed, telemedicine continues to be widely used. According to the 

2004 TRC Report on Telemedicine Activity (Telemedicine Research Center and 

Telemedicine Information Exchange),2 48,194 non-radiology teleconsultations took place 

in 2003 in 46 states. Mental health, cardiology, dermatology, orthopedics, and neurology 

represent some of the clinical specialties most actively utilizing telemedicine services. 

This report also identified a number of barriers to telemedicine services. The most 

significant of these barriers are the difficulty associated with integrating telemedicine 

services into health care delivery, lack of long-term funding, and lack of reimbursement 

for the provision of telemedicine services.2

Despite the peer-reviewed literature representing only a subset of all telemedicine 

experience, it is important to analyze telemedicine using an evidence-based approach, 

especially when the goal is to inform decisions about coverage. As such, this report 

undertakes a systematic if limited review of the efficacy for the telemedicine services and 

usages described above. 

Definitions 

Telemedicine is the use of telecommunications technology for medical diagnostic, 

monitoring, and therapeutic purposes when distance and/or time separates the 

participants. Some descriptions use the broader term telehealth to indicate care beyond 

that provided in medical encounters (e.g., health education, health-related Web sites, 

etc.). Other descriptions use narrower terms focused on medical specialties, such as 
12

teledermatology or teleradiology. A telemedicine encounter is the event where clinical 

services are provided using telemedicine. The narrower term teleconsultation is used 

when a traditional specialist medical consultation is performed using telemedicine. 

Telemedicine Study Areas 

 This report examines telemedicine services in three areas: store-and-forward, homebased, and office/hospital-based services. Each of these three services are evaluated for 

their efficacy in three functions: diagnosis and management decisions, clinical 

outcomes, and access to care. Because the decision to use telemedicine is only 

predicated on it performing comparably to face-to-face care, studies are assessed from the 

standpoint of telemedicine to perform comparable to, but not necessarily better than, 

conventional care. 

 The terminology used in this update varies from the terminology used in the 2001 

report. The term self-monitoring/testing has been replaced with home-based, and the 

term clinician-interactive has been replaced with office/hospital-based. The updated 

terms more accurately reflect the services that they describe and match the terminology 

used in subsequent publication of the findings of the 2001 evidence report in the peerreviewed literature.3, 4

Store-and-forward telemedicine services collect medical data, store them, and then 

forward them to be interpreted later. Store-and-forward systems provide the ability to 

capture and store digital still or moving images of patients, as well as audio and text data. 

A store-and-forward system eliminates the need to have the patient and the specialist 

available at the same time. Store-and-forward is therefore an asynchronous, noninteractive form of telemedicine. It is usually employed as a clinical consultation (as 

opposed to an office or hospital visit). 

Home-based telemedicine services enable physicians and others to monitor 

physiologic measurements, test results, images, and sounds, usually collected in a 

patient’s residence or a nursing facility. Post-acute-care hospital patients, patients with 

chronic illnesses, and patients with conditions that limit their mobility often require close 

monitoring and follow-up. These patients also may be taking medications that require 

testing and/or titration of dosage. 

Telemedicine systems use a variety of strategies to accomplish this monitoring. For 

example, several technologies allow patients to upload monitoring data directly to a 

health care system or to enter it into a home computer, whereby it can be transferred to a 

provider. Others make use of high-bandwidth phone or cable television infrastructure to 

apply two-way interactive video, audio, and medical diagnostic instrumentation. The 

close monitoring afforded by these approaches may allow better health care through early 

detection of problems or more precise dosing of medications and biologic agents, 

potentially reducing costs. 

Some common forms of home-based telemedicine services are blood pressure 

measurement and blood glucose measurement performed by a diabetic patient and used 

by a clinician to evaluate the patient’s glycemic control and to recommend changes in 

management. Other medical conditions for which home-based telemedicine services 

have been developed include asthma (in which spirometry is measured), congestive heart 

failure (weights, symptoms, blood pressure), cardiac arrhythmias (electrocardiography), 
13

anticoagulation therapy (prothrombin time), and post-acute hospital care. Monitoring 

may facilitate preventive measures to be taken before problems get so severe that 

hospitalization becomes necessary. Telemetry devices could also provide a more costeffective method of care, by reducing medical visits for conditions that are not severe. 

Home-based telemedicine systems also may enhance patient-provider communication. 

Office/hospital-based telemedicine services are real-time, clinician-patient 

interactions that conventionally would require face-to-face encounters between a patient 

and a health professional. Examples of office/hospital-based services that might be 

delivered by telemedicine include office visits, hospital visits, consultations, and home 

visits, as well as a variety of specialized examinations and procedures. 

Telemedicine is commonly used to make diagnosis or management decisions, often 

by a specialist located remotely from the patient. Because many diagnostic decisions in 

medicine are not made definitively, it is often adequate to demonstrate that telemedicine 

results in concordant as opposed to accurate decisions. This is particularly true in 

specialties like dermatology, where diagnoses are made by visualizing skin lesions and 

not confirmed with definitive testing before treatment is begun. Making accurate 

decisions usually requires more definitive testing, such as biopsies, which are not 

routinely done for many conditions, especially those that are not life-threatening. 

For this reason, we distinguish in this report between concordance and accuracy in 

making diagnoses. We note other dimensions of concordance, such as the measure used 

(usually either percent agreement or Cohen’s kappa measure for categorical data and 

correlation for continuous data), comparison to the same diagnostician (intraobserver) 

versus a different one (interobserver), and whether concordance of telemedicine versus 

face-to-face diagnosis is compared to face-to-face versus face-to-face diagnosis. Studies 

of the highest quality must include the latter as a reference to the comparison of 

telemedicine. In our original report, few studies made this important comparison. 

Accuracy is usually measured by comparison with some gold standard using sensitivity 

and specificity. 

The clinical outcomes assessed in this study are limited to measures of clinical care, 

such as health status, improvement in clinical parameters (e.g., blood glucose or blood 

pressure), and recovery from disease. We do not focus on utilization or economic 

outcomes. 

This review has a number of limitations of scope. Our gathering of evidence is 

limited to the peer-reviewed literature. Only studies assessing populations relevant to 

Medicare (non-pregnant adults) are assessed. Studies focusing on non-clinical care 

(teleradiology and telepathology) are excluded, as are those focusing on economics as 

well as patient or provider satisfaction. We also do not look explicitly at telemedicine 

from the context of changes in the health care system or implementation of wider 

information technologies unless such aspects were specifically assessed in peer-reviewed 

studies. 

Other Telemedicine Research Summaries 

Several other reports have analyzed the quality of telemedicine studies, some of 

which are systematic reviews. These include: 
14

Bashshur R, Shannon G, Sapci H. Telemedicine evaluation. 2004. In: Proceedings of the 

Second International Symposium on the Future Directions for Telemedicine; 2004 May 

22-24; Ann Arbor, MI. 

Brantley D, Laney-Cummings K, and Spivack R. Innovation, Demand and Investment in 

Telehealth. 2004, Department of Commerce: Washington, DC. 

http://www.technology.gov/reports/TechPolicy/Telehealth/2004Report.pdf. 

Currell R, et al., Telemedicine versus face-to-face patient care: effects on professional 

practice and health care outcomes, in The Cochrane Database of Systematic Reviews. 

2000, Update Software: Oxford, UK. CD002098. 

Grigsby J, Brega A, DeVore P. Health services research and evidence of telemedicine. In: 

Proceedings of the Second International Symposium on the Future Directions for 

Telemedicine; 2004 May 22-24; Ann Arbor, MI. 

Hailey D, Ohinmaa A, Roine R. Study quality and evidence of benefit in recent 

assessments of telemedicine. J Telemed Telecare 2004 10(6):318-24. 

Heinzelmann P et al. A review of clinical outcomes in telemedicine/telehealth. In: 

Proceedings of the Second International Symposium on the Future Directions for 

Telemedicine; 2004 May 22-24; Ann Arbor, MI. 

Hersh W, Wallace J, Patterson P, et al. Telemedicine for the Medicare Population. 

Evidence Report/Technology Assessment No. 24. Rockville, MD: U.S. Department of 

Health and Human Services, Agency for Health Care Quality and Research. 2001 Jul. 

AHRQ Publication No. 01-E102. 

Jennett P, Scott R, Hailey D, et al. Socio-Economic Impact of Telehealth: Evidence Now 

for Health Care in the Future: Volume One: State of the Science Report. 2003, Health 

Telematics Unit, University of Calgary: Calgary, AB. 
15

Chapter 2. Methods 

 Evidence reports aim to define the limits of the evidence, clarifying when assertions 

about the value of the intervention are based on strong evidence from clinical studies. 

The quality of the evidence on effectiveness is a key component, but not the only 

component, of decision-making on coverage decisions. Both national and local Medicare 

coverage determinations are also based on whether a service has been determined to be 

“reasonable and necessary” based on “descriptive information, and scientific and clinical 

evidence.”5

 

 The Medicare Payment Advisory Commission has recognized the value that 

telemedicine services can add to patient care, particularly following the passage of the 

Medicare, Medicaid, and SCHIP Beneficiary Act of 2000 (BIPA.)6

 However, the 

potential for overuse of telemedicine services and the need for demonstrated efficacy of 

telemedicine services prior to making coverage decisions remains an overriding concern. 

Analytic Framework and Key Questions about the 

Efficacy of Telemedicine Services 

 To determine the key questions and guide the review of the literature in the evaluation 

of telemedicine, we developed an analytic framework, as shown in Figure 1. 

Figure 1. Analytic framework

 

 We then made explicit the key questions for each of the three study areas. For studies 

of diagnosis and management decisions and of clinical outcomes, the key questions were 

assessed from the standpoint of determining whether the telemedicine system provided 

comparable care, since telemedicine can be deemed efficacious when the quality of 

clinical care provided is as good as, but not necessarily better than, in-person care. 

Patient 

populations 

relevant to 

Medicare 

Telemedicine 

encounter

Effects on access to 

care 

Effects on diagnosis 

and recommendations 

for management 

Health 

outcomes 
16

A. Store and forward 

1. Does store-and-forward telemedicine result in comparable diagnostic decisions 

and recommendations for clinical management? 

2. Does store-and-forward telemedicine result in comparable health outcomes? 

3. Does the availability of store-and-forward telemedicine services improve access 

to care? 

B. Home-based 

1. Does home-based telemedicine result in comparable diagnostic decisions and 

recommendations for management? 

2. Does the use of home-based telemedicine result in comparable health outcomes?

3. Does the use of home-based telemedicine improve access to care?

C. Office/hospital-based 

1. Does office/hospital-based telemedicine result in comparable diagnosis and 

appropriateness of recommendations for management? 

2. Does office/hospital-based telemedicine result in comparable health outcomes? 

3. Does the availability of office/hospital-based telemedicine improve access to 

care?

Literature Search Strategy 

 We searched the literature for information about ongoing telemedicine programs, 

activities, and services. This search focused on obtaining English-language journal 

articles and reports pertaining to the three study areas. We identified programs from the 

following: 

 Electronic bibliographic database. The search strategy was similar to that used in the 

prior report. It was designed to find any publications about telemedicine and was used to 

search the MEDLINE® database using Ovid, version 19.2.0. The key MeSH terms 

associated with the search include telemedicine, remote consultation, telecommunications

and delivery of health care. Appendix A*

 details the complete search string. The initial 

search, which identified telemedicine articles published between January 2000 and June 

2004, resulted in 3,848 citations. An update of the same strategy in November 2004 

yielded 224 additional citations. Other databases, such as EMBASE® and CINAHL®, 

were not searched, since their coverage tends to duplicate MEDLINE® for telemedicine. 

Reference lists. Reference lists of previously published telemedicine systematic 

reviews were searched, resulting in the inclusion of 11 studies to those identified by our 

search strategy. Of these 11 studies, six were subsequently included following 

application of the inclusion criteria. Reference lists of included studies also were 

searched.

 

*

 Appendices cited in this report are provided electronically at 

http://www.ahrq.gov/downloads/pub/evidence/pdf/telemedup/telemedup.pdf. 
17

Selection of Abstracts and Full-Text Articles 

 The results of the literature search and selection of articles for inclusion are shown in 

Figure 2. All citations were entered into an EndNote® database and were tracked based 

on inclusion/exclusion status throughout the literature review process. 

 Four reviewers (WRH, DHH, SMS and TLD) conducted independent screening 

reviews of all citation titles and abstracts (if available) obtained from the citation 

acquisition. The citations were dually reviewed. The reviewers read citation titles and 

abstracts (or titles only if the abstract was not available) to make inclusion decisions for 

subsequent full-text review. The full-text articles were divided by key question and 

forwarded to the appropriate investigator for inclusion/exclusion assessment. Table 1 

lists the inclusion and exclusion criteria for both the title/abstract level and the full-text 

level. The inclusion criteria were that the study be relevant to at least one of the three 

study areas; that it address at least one key question in the analytic framework for that 

study area; and that it contain reported results (i.e., “data”). Exclusion criteria were that 

the study did not address a key question, addressed a key question but did not contain 

reported results, had a study population that was not relevant to the Medicare population, 

or that the service did not require face-to-face encounters (i.e., radiology or pathology 

diagnosis). For the store-and-forward area, we included studies that used store-andforward techniques as well as studies that used systems that could be easily adaptable to 

store-and-forward. We excluded reports of telephone care programs and equivalent 

programs that used electronic mail instead of the telephone, although programs that used 

electronic mail as a substitute for face-to-face encounters were included. We also 

excluded studies of services that provided medical advice directly to the public. 

 Reliability of the inclusion/exclusion decisions was assessed by noting the percent of 

agreement and kappa values for each pair of reviewers (Table 2). Generally, agreement 

regarding inclusion or exclusion was high among the reviewers. We retrieved the fulltext articles for citations selected for possible inclusion by either reviewer. 
18

Figure 2. Results of literature search and abstract review

Note: Articles may fit into more than one key question category. 

MEDLINE® search 

4,083 

(Initial search result of 3,848 

+ 224 search update of 11/04 

+ 11 from reference lists) 

Diagnosis and Outcomes 

management 

Access 

356 145 97

597 

Total number of 

full-text retrieved 

Level 2 

Full-text 

articles 

reviewed 

52 14 34 

Level 3 

Full-text 

articles 

included 

100 
19

Table 1. Inclusion/exclusion criteria 

Code # Explanation 

 Inclusion 

1 KEY QUESTION AND DATA 

Addresses a key question on one of the service areas and contains data (results) 

 

Exclusion 

2 NO KEY QUESTION 

Does not address a key question 

3 KEY QUESTION, NO DATA 

Addresses a key question, but does not contain data 

4 WRONG POPULATION 

Addresses key question and contains data, but population of study is outside our scope 

5 GOOD BACKGROUND MATERIAL and/or REVIEW 

However, does not meet inclusion criteria 

6 OTHER 

Indicate reason 

Table 2. Inter-rater reliability 

Reviewers Percent agreement Kappa value 

WRH, SMS 89.5 .56 

WRH, TLD 91.9 .59 

DHH, SMS 85.8 .40 

DHH, TLD 91.2 .42 

Data Abstraction 

All studies rated as relevant on the basis of review of titles and abstracts were 

retrieved, photocopied, and distributed to one of the investigators (WRH or DHH). 

Studies judged to have evidence about a key question were then abstracted. For each key 

question, data from each study were abstracted using electronic abstraction forms 

(Appendix B1), and entered into an evidence table. Evidence tables are presented in full 

in Appendix C.* A second investigator reviewed all studies included in evidence tables 

to verify the evidence table content. The study quality ratings of all included studies 

were assigned at this time (see further details in the next section). A complete list of 

excluded studies appears in Appendix D.*

Assessment of Study Quality 

 We critically appraised the included studies for each study area and key question. 

Studies that examined the effect of telemedicine activities on clinical outcomes or 

management were rated for quality according to the scale shown in Table 3.7

 The optimal 

design for studies of a diagnostic test is different from the optimal design for studies of 

therapies. For this reason, we used a separate scale to rate the quality of studies that 

compared the accuracy of “telediagnoses” to diagnoses made in conventional clinical 

encounters (Table 4). We also abstracted features of the study design that were likely to 

be associated with bias in studies of diagnostic test performance.8, 9 We paid particular 

 

1

 Appendices cited in this report are provided electronically at 

http://www.ahrq.gov/downloads/pub/evidence/pdf/telemedup/telemedup.pdf. 
20

attention to known problems in telediagnosis studies, such as small sample sizes (less 

than 10-20 patients), selective application of definitive diagnosis testing, and 

insufficiently long follow-up to determine diagnosis when a gold-standard test was not or 

could not be performed. 

Table 3. Classification of evidence for studies of clinical outcomes 

Study Class Characteristic 

I Properly designed random controlled trials 

II Random controlled trials that contain design flaws preventing 

specification of Class I 

Properly designed trials with control groups not randomized 

Multi-center of population-based longitudinal (cohort) study 

Case control studies 

III Descriptive studies (uncontrolled case series) 

Clinical experience 

Expert opinion 

Case reports 

Table 4. Classification of evidence for diagnostic and management decisions 

Study Class Characteristic 

I Case series of consecutive patients from relevant population of 

individuals who would use telemedicine; using an objective gold 

standard with blinded interpretation of results; with inter-observer 

analysis 

II Case series of patients from relevant population of individuals who 

would use telemedicine; using an objective gold standard 

III Case series not from relevant population or not using appropriate 

methodology for diagnostic test evaluation 

 In appraising studies addressing access to care, we adapted criteria described by the 

Institute of Medicine (IOM)10 as applied to the use of telemedicine. The model of access 

to care incorporated three types of indicators: barriers (structural, financial, and 

personal); utilization; and outcomes (mortality, well-being, or functionality). The IOM 

has recommended that studies of access to care measure both utilization and outcomes, 

and our criteria included both measures. Studies that examined only outcomes of care 

were assigned to the Outcomes category rather than to the Access category. 

 The definition of access that we used had originally been proposed in a report by the 

IOM published in 19937

 and had been widely disseminated prior to the period of time 

covered by the studies reviewed for the current report. Other models of access to care 

have been described,11, 12 but these models include elements of staff deployment and 

scheduling strategies that have rarely been addressed in studies of telemedicine. Thus, 

we found the IOM model to be best suited to the published literature in this domain. 

 Studies of access to care were rated for quality according to the scale shown in Table 

5. Review of the studies of access in the original report1

 showed that the majority relied 

on utilization indicators alone. A few used indicators of reduced barriers to care. Most 

studies used models of access that included 1) increased opportunity to obtain a service 

locally, and 2) reduced amount of time for seeking and/or obtaining care. 

 
21

Table 5. Classification of strength of evidence for studies of access to care 

Study Class Characteristic 

I Appropriately comparable comparison group not exposed to telemedicine 

services; valid measures of utilization and outcomes 

II Appropriately comparable comparison group not exposed to telemedicine 

services; valid measure of utilization 

III Comparison group absent or not comparable in some respects; valid measure of 

utilization; outcomes may also be measured 

 Studies in all categories also were classified using a four-level scale that summarized 

the strength of the study’s findings for direction of effect (Table 6). This classification 

system was modified from the system used in the original report1

 to reflect that the key 

questions require only that home-based telemedicine be comparable to rather than 

superior to conventional care. For those studies, the goal was now to determine whether 

diagnostic and management decisions or clinical outcomes were comparable, rather than 

determining the directionality of an effect. Studies were classified as clearly comparable 

when the confidence for measures of association was high and probably comparable 

when those measures were lower. The difference in these definitions of direction of effect 

had a small effect on the classification of studies given a quality rating of I when 

comparing the findings of the original report and the current report. 

Table 6. Classification of direction of effect 

A Strong improvement or clearly comparable 

B Weak improvement or probably comparable 

C Conflicting evidence for improvement or comparability 

D Negative effect (evidence that technology does not provide 

comparability or improvement) 

 Because of the larger evidence base for studies of diagnosis/management and clinical 

outcomes, we excluded Class III studies from the analysis in these categories. Class III 

studies were included in the evidence tables for access to care. We included tallies of 

Class III studies in all summary tables that show the number of studies and their class and 

effect for each specialty. 

Data Synthesis 

 Results of the evidence report update are presented in full in the evidence tables 

(Appendix C2

). The investigator for each key question constructed separate evidence 

tables for each of the three study areas. In general, the evidence tables include 

author/date, key research question(s), study design/level, population, sample/selection, 

measures, results, quality rating, and limitations. 

 For the study areas with more than two studies, we constructed a summary table of 

specialties or domains and the strength of the evidence for each key question and type of 

telemedicine. The efficacy for telemedicine can therefore be gleaned from the number of 

 

2

 Appendices cited in this report are provided electronically at 

http://www.ahrq.gov/downloads/pub/evidence/pdf/telemedup/telemedup.pdf. 
22

studies that have a “positive” direction of effect, i.e., are rated A or B. For those 

procedures or services that have evidence, the summary tables show which analytic 

framework links are supported by evidence. We also interpret our synthesis and discuss 

the limitations of our approach to this evaluation. 

Peer Review Process 

 Thirteen peer reviewers were selected based on their expertise in the field of 

telemedicine and their availability to review the draft report. Refer to Appendix E3 for 

the list of peer reviewers. The draft report was submitted to the peer reviewers along 

with a peer review form. The review form was developed by the research team and was 

based on one used in our original study and those used by other research teams at the 

Oregon Evidence-based Practice Center. The peer reviewers had three weeks to respond. 

The comments from the peer reviewers were received and distributed to the investigators 

for their consideration and response. A spreadsheet was prepared that contained the 

comments of the peer reviewers and our response to them. The peer review comments 

aided in creating this improved, comprehensive final document. 

 

3

 Appendices cited in this report are provided electronically at 

http://www.ahrq.gov/downloads/pub/evidence/pdf/telemedup/telemedup.pdf. 
23 

Chapter 3. Results 

Overview of Peer-reviewed Studies 

As in the previous report, there were a large number of studies that met our 

inclusion criteria (Table 7), yet the methodology of many studies was weak (Table 8). 

Only a quarter of the studies met the criteria for Class I methodology, and even these had 

problems such as relatively small sample size and inadequate description of study details, 

such as concealment of allocation and other aspects of the randomization process. Some 

studies were included in more than one telemedicine study area. 

Table 7. Summary of included studies 

UPDATE ORIGINAL REPORT 

Modality Diagnosis 

and 

management 

Access Outcomes Total Diagnosis 

and 

management 

Access Outcomes Total 

Store and 

forward 

30 5 0 35 22 2 0 24 

Homebased 2 0 25 27 4 2 19 25 

Office/ 

hospitalbased 

20 9 9 38 33 7 6 46 

Total 52 14 34 100 59 11 25 95 

Table 8. Summary of studies by key questions and results 

Summary by key question Total I-A I-B I-C II-B II-C II-D III-B III-C 

Diagnosis and 

management store-andforward 

30 2 3 2 21 2 0 

Diagnosis and 

management home-based 

2 0 0 0 0 2 0 

Diagnosis and 

management 

office/hospital-based 

20 1 3 1 13 2 0 

Diagnosis and 

management total 

52 3 6 3 34 6 0 

Outcomes store-andforward 0 0 0 0 0 0 0 

Outcomes home-based 25 6 2 0 17 0 0 

Outcomes office/hospitalbased 9 2 0 0 6 1 0 

Outcomes total 34 8 2 0 23 1 0 

Access store-and-forward 5 0 1 0 1 0 0 2 1 

Access home-based 0 0 0 0 0 0 0 0 0 

Access office/hospitalbased 9 0 1 1 3 1 0 3 1 

Access total 14 0 2 1 4 1 0 5 2 

All total 100 11 10 4 61 8 0 5 2 

Another problem with many of these studies concerns a statistical issue. As noted 

earlier, the goal of most telemedicine studies is only to show that telemedicine is 

“comparable” to in-person care, not necessarily “better,” especially when it can provide 

that care with decreased cost, increased convenience, and/or access to care when none 
24 

was previously available. One way to determine whether two approaches are comparable 

is to show there is no statistically significant difference between them. However, lack of 

statistical significance can also occur even when there is a difference, but the study lacks 

adequate statistical power to detect it. For this reason, studies with small sample sizes 

should compute, in addition to an alpha value (the well-known p value), the value of beta. 

This value estimates the probability that a difference between two comparison groups 

truly exists when the study results fail to show a difference (also known as a type 2 error). 

Virtually none of the studies we reviewed assessed beta error, and as such, the “statistical 

comparability” may exist because there was inadequate statistical power to show 

otherwise. 

In assessing diagnostic and management decision studies, a Class I study had to 

include not only a comparison of the telemedicine and in-person decisions but also one of 

the following: 

• In the case of concordance studies, a comparison of a “baseline” concordance 

between two or more face-to-face examiners, 

• In the case of accuracy studies, have measurement against a suitable “gold 

standard” with measures such as sensitivity and specificity. 

Therefore, when there was just a comparison of telemedicine and in-person 

concordance, the study was rated as Class II. Studies were also rated as Class II when the 

diagnostic assessment did not include a definitive gold standard consisting of an objective 

test (e.g., biopsy) or a commonly accepted clinical judgment (e.g., visual findings on 

gastrointestinal endoscopy or of diabetic retinopathy). Class III studies were excluded 

from our analysis of diagnosis and management decisions. 

For the strength of evidence, a grade of A or B was given when the study set out to 

demonstrate comparability and did so. Class II studies were not graded higher than B, 

since studies with this level of methodology do not have the quality of evidence to 

provide convincingly strong results. 

For outcomes studies, a Class I study had to be a randomized controlled trial (RCT). 

RCTs with clear and obvious flaws were rated as Class II, as were cohort, pre-post, and 

observational studies. For the strength of evidence, a grade of A or B was given when 

the study set out to demonstrate comparability and did so, or when the study set out to 

show superiority of telemedicine and did so. Similar to diagnostic and management 

efficacy studies, Class II studies of outcomes were also not graded higher than B. 

Store-and-Forward Telemedicine 

 Similar to our original evidence report, the studies we found of store-and-forward 

telemedicine only assessed diagnosis or management decisions and access to care, but not 

clinical outcomes (Evidence Tables 1 and 21). As we also found in the original report, 

some aspects of the telemedicine systems in home and office-hospital settings made use 

of store-and-forward techniques, but in the context of larger and/or interactive 

interventions. A summary of all studies by medical specialty is shown in Table 9, which 

 

1

 Evidence tables cited in this report are provided electronically at 

http://www.ahrq.gov/downloads/pub/evidence/pdf/telemedup/telemedup.pdf in Appendix C. 
25 

also includes a tally of those from our original report. Studies graded A or B for effect 

indicate comparability for telemedicine. 

Table 9. Summary of studies of store-and-forward telemedicine for diagnosis and/or management 

decisions 

UPDATE Total I-A I-B I-C II-B II-C II-D III-B III-C 

Dermatology 13 2 9 2 

Gastroenterology 2 2 

Gynecology 3 2 1 

Ophthalmology 5 2 1 2 

Plastic Surgery 7 7 

Total 30 2 3 2 21 2 0 

ORIGINAL Total I-A I-B I-C II-B II-C II-D III-B III-C

Ambulatory Care 1 1 

Dentistry 1 1 

Dermatology 9 2 5 2 

Neonatology 1 1 

Ophthalmology 5 2 1 1 1 

Otolaryngology 2 1 1 

Wound Care 1 1 

Total 20 0 2 0 9 3 1 5 

Also similar to the original report, the largest number of studies came from the 

specialty of dermatology (Table 9). Of the 13 studies published since the last report, ten 

assessed some aspect of concordance, and four looked at accuracy. One study assessed 

aspects of both. Of the concordance studies, eight assessed diagnostic decisions and four 

assessed management decisions; two studies assessed both. Two of the diagnostic studies 

looked at some aspect of intraobserver concordance, while the remainder assessed 

interobserver concordance. 

The most commonly assessed aspect of teledermatology was interobserver 

concordance.13-19 The range of concordance varied widely, from 41 percent to 87 percent 

for complete agreement to 51 percent to 96 percent for disease-category agreement. 

Unfortunately, all of these studies were limited by the lack of measurement of 

concordance among more than one face-to-face examiner. In other words, none of the 

studies compared face-to-face versus telemedicine agreement with face-to-face versus 

face-to-face agreement. As such, none of the studies could be rated as Class I. In our 

previous report, two studies did assess concordance of face-to-face examiners.20, 21 

Concordance studies assessing management decisions typically looked at decision to 

biopsy. While one study found complete agreement,22 others found lesser concordance.13, 

23-25

The studies of diagnostic accuracy typically compared the telemedicine diagnosis to 

some sort of gold standard, often a biopsy of a pigmented lesion.13, 23, 26, 27 Most of these 

studies did not calculate statistical significance, but some did show a trend towards less 

accuracy for telemedicine. 

Store-and-forward applications of teledermatology have generally used commonly 

available digital cameras and varying techniques for storing and transmitting the digital 

photographs. Teledermoscopy is a technique by which a low-power lens is used to 

generate a magnified image of a discrete skin lesion. This methodology was tested in two 

studies of store-and-forward techniques and found to be comparable to face-to-face 

diagnosis of pigmented lesions.26, 27
26 

The second most frequently studied clinical area was wound care. Seven studies, all 

Class II, demonstrated that some characteristics of skin wounds and ulcerations could be 

assessed effectively using store-and-forward telemedicine. However, most of these 

studies had small numbers of patients and very small numbers of clinicians, raising the 

statistical power issues described above. 

Five studies provide data on store-and-forward applications in ophthalmology. Four 

of these studies show that a high accuracy of diagnosing diabetic retinopathy (DR) could 

be obtained.28-31 One of them found, however, that concordance was lower for severity 

of DR and specific abnormalities.31 

Other specialties studied include gynecology and gastroenterology. The gynecology 

studies assessing colposcopy were hindered by the limitations of that procedure even 

when done in person.32, 33

 Five studies published in 2000-2004 reported evidence on the effect of store-andforward techniques upon access to care. The clinical domains of these five studies are 

summarized in Table 10. Details of the studies’ designs and findings are provided in 

Evidence Table 2.2

 The methodological quality of these studies generally was low. 

Table 10. Summary of studies of the effects of store-and-forward telemedicine on access to care 

UPDATE Total I-B II-B III-B III-C 

Dermatology 2 1 1 

Ophthalmology 1 1 

General Surgery 1 1 

Multiple Specialties 1 1 

Total 5 1 1 2 1 

ORIGINAL Total I-B II-B III-B III-C 

Dermatology 2 1 1 

The studies of access provide information about how telemedicine systems have been 

deployed in real-world situations and thereby provide an estimate of the actual clinical 

impact of the systems. All of the studies measured utilization of traditional (nontelemedicine) clinical services following the telemedicine intervention, and all reported 

the proportion of patients for whom the telemedicine service was the only care received 

in the index clinical episode. However, two of the studies34, 35 collected no data to assess 

whether the care provided by the telemedicine service was adequate. 

All of the studies that included data on access to care examined the deployment of 

store-and-forward telemedicine systems for screening patients referred for medical or 

surgical specialty services following referral by clinicians in primary care or general 

practice settings. One study36 used only text information submitted by electronic mail, 

while the other four studies all were based on the collection of digital photographs, 

usually to supplement conventional clinical information submitted in a text format. The 

effect on utilization of specialty services was generally modest. In the two studies of 

teledermatology, more than 80 percent of patients were recommended to have subsequent 

face-to-face evaluations by dermatologists.37, 38 In a randomized trial of all specialty 

consultation requests in a rural Finnish community, the electronic mail-based store and 

forward system had no effect on the proportion of patients who received follow-up care 

in the local community rather than at the regional centers providing specialty services.36 

 

2

 Evidence tables cited in this report are provided electronically at 

http://www.ahrq.gov/downloads/pub/evidence/pdf/telemedup/telemedup.pdf in Appendix C. 
27 

The two other studies34, 35 used photography-based screening systems by which the 

majority of patients were recommended not to have specialty follow-up. However, these 

studies were of relatively low quality and did not collect any follow-up information on 

the screened patients. 

The only study of access to care that was given a Class I rating evaluated a store-andforward technique for screening primary care patients referred for dermatologic 

consultation in a Veterans Affairs medical center.38 That study was a randomized trial 

that included a measure of the time to completion of the consultation. Dermatologists 

evaluating the patients randomized to teledermatology could determine the time interval 

to a face-to-face dermatology appointment, while patients randomized to the 

conventional care group had only a routine appointment scheduled. Patients randomized 

to the teledermatology group had significantly shorter time intervals until the face-to-face 

appointment. We judged this to be an unfair comparison, because the study design itself 

favored improved access to care for the teledermatology group. Since it is likely that the 

hospital in which the study was conducted had a fixed number of appointment slots for 

the dermatology clinic, scheduling sooner appointments for patients in the 

teledermatology group would tend to reduce the pool of available appointments and cause 

the appointments available to the patients randomized to the conventional care group to 

be, on average, further distant in time. 

Home-Based Telemedicine 

In contrast to store-and-forward telemedicine, though similar to our original report, 

most studies of home-based telemedicine evaluated the clinical outcomes of interventions 

(see Table 11). Two studies did assess diagnostic capabilities in the home, finding 

various amounts of agreement and disagreement depending on the observation (see 

Evidence Table 33

). Most outcomes studies included patients with chronic diseases 

common in the Medicare population, such as congestive heart failure, diabetes mellitus, 

coronary artery disease, and hypertension (see Evidence Table 4*). 

Table 11. Summary of studies of home-based telemedicine for clinical outcomes 

UPDATE Total I-A I-B I-C II-B II-C II-D III-B 

Congestive 

Heart Failure 

6 1 1 4 

Chronic 

Disease 

3 1 2 

Coronary 

Artery Disease 

2 1 1 

Diabetes 

Mellitus 

5 1 1 3 

Hypertension 3 1 2 

Lung 

Transplantation 

1 1 

Multiple 

Sclerosis 

1 1 

Spinal Cord 

Injury 

1 1 

Obesity 1 1 

 

3

 Evidence tables cited in this report are provided electronically at 

http://www.ahrq.gov/downloads/pub/evidence/pdf/telemedup/telemedup.pdf in Appendix C. 
28 

Table 11. Summary of studies of home-based telemedicine for clinical outcomes (continued)

UPDATE Total I-A I-B I-C II-B II-C II-D III-B 

Psychiatry 1 1 

Pulmonary 

Medicine 

1 1 

Total 25 6 2 0 17 0 0 

ORIGINAL Total I-A I-B I-C II-B II-C II-D III-B

AIDS 2 1 1 

Alzheimer's 1 1 

Cardiology 1 1 

Chronic 

Disease 

3 1 1 1 

Diabetes 

Mellitus 

10 1 1 8 

Hypertension 2 1 1 

Neonatology 1 1 

Pulmonary 1 1 

Total 21 3 6 0 10 0 0 2 

A common characteristic of the studies of home-based telemedicine was that the 

intervention included dedicated staff (usually nursing staff) that monitored the data 

recorded in the home and developed clinical management plans. Some of the studies 

were randomized controlled trials that compared such systems (technology and dedicated 

staff) to conventional care (such as visiting nurse services). These studies found 

improved outcomes with the telemedicine-based interventions, but the design of the 

studies made it difficult to discern the benefit of the dedicated program staff from the 

telemedicine intervention. 

While a small number of the studies were well-designed RCTs,39-43 the rest were 

limited by either small sample sizes and/or control groups of dubious value. In addition, 

while all of the studies assessed achieved at least comparable benefits in clinical 

outcomes, and thus obtained an effect rating of A or B, the value of such comparability 

(e.g., same but not better blood sugar control or weight loss) was not clear. 

Three studies of chronic disease in the elderly showed benefit of the dedicated 

programs in both patient functional status and reduced emergency department visits and 

hospital admissions.40-44 Some interventions tailored for specific diseases were found to 

be effective in congestive heart failure (CHF), hypertension, and pulmonary disease.39, 42-

45 Other home-based interventions, such as blood sugar measurements intended to 

improve management of diabetes mellitus, were not found consistently superior to usual 

care.46-50 Interventions in other domains, such as obesity51 and lung transplantation,52

also failed to show benefit over usual care. 

While two studies were identified in the original report that examined the effect of 

home-based telemedicine systems on access to care, no studies were identified in the 

2000-2004 period. Home-based systems have nearly always been used to enhance the 

care of patients who already receive conventional clinical services, either through clinic 

visits or via home care agencies. The primary rationale for home-based telemedicine is 

to improve data collection and/or communication rather than to supplant conventional 

care (such as clinic or home visits). Thus, the lack of studies examining conventional 

measures of access to care is not surprising. Expanded definitions of access to care, such 

as “patient-centered access”11 are applicable to home-based systems and may provide 

suitable models for future research on the deployment of home-based systems.
29 

Office/Hospital-Based Telemedicine 

Studies of office/hospital-based telemedicine provide evidence on diagnosis and 

management decisions (see Table 12 and Evidence Table 54

), clinical outcomes (see 

Table 13 and Evidence Table 6*

), and access to care (see Table 14 and Evidence Table 

7*).

For diagnosis and management decisions, the most commonly studied specialty was 

ophthalmology. As with store-and-forward studies, some aspects of ophthalmologic 

evaluation were amenable to interactive telemedicine, while others were not. One Class I 

study showed rates of disagreement in eye injuries under 10 percent,53 while another 

found disagreement was consistently higher with telemedicine than when comparing two 

in-person evaluations.54

Other frequently studied specialties included neurology and psychiatry. Although the 

studies were rated Class II, two studies showed neurological diagnosis was highly 

concordant55, 56 and two studies showed that the NIH Stroke Scale could be reliably 

administered via telemedicine.57, 58 A few Class II studies demonstrated concordance on 

a variety of psychiatric scales.59-61 Studies in other specialties, such as dermatology,62

rheumatology,63 and vascular surgery64 demonstrated that some diagnostic assessments 

can be successfully administered interactively via telemedicine. 

Table 12. Summary of studies of office/hospital-based telemedicine for diagnosis and/or 

management decisions 

UPDATE Total I-A I-B I-C II-B II-C II-D III-B III-C 

Cardiology 2 2 

Dermatology 1 1 

Gastroenterology 1 1 

Neurology 4 4 

Ophthalmology 5 1 1 1 2 

Otolaryngology 2 1 1 

Psychiatry 3 1 2 

Rheumatology 1 1 

Vascular Surgery 1 1 

Total 20 1 3 1 13 2 0 0 0 

ORIGINAL Total I-A I-B I-C II-B II-C II-D III-B III-C

Cardiology 5 1 3 1 

Dentistry 1 1 

Dermatology 7 2 5 

Emergency 

Medicine 

3 3 

Neurology 2 1 1 

Ophthalmology 2 1 1 

Otolaryngology 2 1 1 

Psychiatry 7 2 5 

Pulmonary 1 1 

Rheumatology 1 1 

Trauma 1 1 

Urology 1 1 

Total 33 0 4 0 15 3 1 2 8 

 Studies of clinical outcomes also showed that for most of the clinical specialties 

assessed, outcomes between conventional and telemedicine interventions were 

 

4

 Evidence tables cited in this report are provided electronically at 

http://www.ahrq.gov/downloads/pub/evidence/pdf/telemedup/telemedup.pdf in Appendix C. 
30 

comparable. However, most of these studies were limited by small sample sizes (with the 

caveats concerning statistical significance described earlier), lack of randomization, and 

assessment of less than the full range of clinical outcomes. None of these studies 

attempted to measure statistical power to avoid beta error. Class I RCTs showing 

comparable outcomes were done in otolaryngology65 and psychiatry.66

Table 13. Summary of studies of office/hospital-based telemedicine for clinical outcomes 

UPDATE Total I-A I-B I-C II-B II-C II-D III-B 

Critical Care 1 1 

Neurology 1 1 

Orthopedics 2 2 

Otolaryngology 1 1 

Psychiatry 3 1 2 

Wound Care 1 1 

Total 9 2 0 0 6 1 0 

ORIGINAL Total I-A I-B I-C II-B II-C II-D III-B 

Dermatology 1 1 

Emergency 

Medicine 

1 1 

Intensive Care 1 1 

Neonatology 1 1 

Neurosurgery 2 2 

Total 6 1 0 0 3 0 0 2 

 The studies of access have examined the use of office-based telemedicine in both 

suburban and rural settings and have examined both specialist evaluations and follow-up 

continuity care. In limited studies of patients with sickle cell anemia67 and patients with 

chronic psychiatric disorders,68 office-based telemedicine appeared to be adequate for the 

ongoing routine care of patients in rural areas, with few problems reported. For new 

evaluations by specialists of patients referred by general practitioners, the use of officebased telemedicine led to a significantly greater rate of diagnostic test utilization than 

face-to-face consultations for neurology patients69 but not for patients needing other types 

of specialty care.70, 71 Two studies compared office-based telemedicine to telephone 

consultations between a referring physician and a specialist.63, 72 Both these studies had 

weak designs but had results suggesting that the telemedicine system provided faster 

access to definitive care. 

Table 14. Summary of studies of the effect of office/hospital-based telemedicine on access to care 

UPDATE Total I-B I-C II-B II-C III-B 

Neurology 2 1 1 

Orthopedics/Rheumatology 3 1 1 1 

Ophthalmology 1 1 

Multiple specialties 1 1 

Psychiatry 1 1 

Hematology 1 1 

Total 9 1 1 3 1 3 

ORIGINAL Total I-B I-C II-B II-C III-B

Neurosurgery 3 2 1 

Cardiology 2 2 

Multiple specialties 2 2 

Total 7 0 0 2 0 5 
31 

Studies of Telemedicine in Non-Medicare Populations 

 A total of 28 studies identified in the literature search were excluded from 

consideration for evidence tables because they were conducted in populations not eligible 

for Medicare services based on their demographic characteristics. All of these 28 studies 

were considered to have evidence potentially applicable to the key questions on the basis 

of the initial title and abstract review. The populations examined in these studies 

included children, pregnant women, incarcerated prisoners, and active duty military 

personnel. These studies were subjected to further review, and twelve were deemed to 

have evidence suitable for inclusion in evidence tables if we had not applied the 

population exclusion. Seven of the studies examined home-based telemedicine, three 

examined store-and-forward techniques, and two examined office-based telemedicine 

applications. The studies’ findings were consistent with the findings of the studies 

included in the evidence tables. We concluded that excluding studies conducted on nonMedicare populations had not biased our overall conclusions. 

33

Chapter 4. Discussion

Evidence about Efficacy 

This update on evidence about the efficacy of telemedicine for the Medicare 

population covered published peer-reviewed literature for the five years between 2000 

and 2004. Similar to the findings of our original report a half-decade ago, there are still 

serious gaps in the evidence base for telemedicine. While this situation is hardly unique 

to telemedicine, having a solid evidence base is essential given that there is increased 

advocacy for health care payers, especially Medicare, to provide coverage for its use. In 

the discussion that follows, we will review telemedicine by specialty in the case of storeand-forward and office/hospital-based telemedicine and by disease domain in the case of 

home-based telemedicine. 

The best evidence for the effectiveness of telemedicine is in medical specialties for 

which verbal interactions are a key component of the patient assessment, such as 

psychiatry and neurology. Various psychiatric and neurological assessments can be 

administered effectively via interactive videoconferencing. Likewise, treatments 

administered in these specialties via telemedicine appear to achieve comparability with 

face-to-face care. It can probably be concluded that medical care administered via 

interactive videoconferencing can achieve results that are comparable to their in-person 

counterparts. 

Our systematic review also identified several studies, a few of them of high 

methodologic quality, showing benefits of home-based telemedicine interventions in 

chronic diseases. These systems appear to enhance communication with health care 

providers and provide closer monitoring of general health, but the studies of these 

techniques were conducted in settings that required additional resources and dedicated 

staff. Deployment of home monitoring technology in the absence of these integrated 

systems is unlikely to be beneficial. Systems designed to facilitate specific aspects of 

care, such as blood sugar and blood pressure measurements, provide less clear benefit. 

With ongoing improvements in telecommunications technology, particularly broadband 

connections to the home, further research, including larger clinical trials, will likely be 

informative. 

The specialty with the largest number of studies is dermatology, and most studies of 

teledermatology have evaluated store-and-forward techniques. The body of evidence 

summarized in this report is consistent with the findings of the earlier report. There 

continues to be highly variable rates of interobserver and intraobserver agreement in 

diagnoses. This issue can only be resolved by high-quality studies that compare not only 

the concordance of telemedicine versus face-to-face diagnosis, but also the concordance 

of face-to-face versus face-to-face diagnosis in the same situation. It should be noted that 

the teleophthalmology field has done this in most of their diagnostic concordance studies. 

The published studies of teledermatology have other flaws as well. For example, 

most of them included only a small number of teledermatologists. Over half of the 

studies we identified used three or fewer teledermatologists. In addition, most of the 

studies deployed teledermatology only in a laboratory type of setting. The few studies of 

real-world use of teledermatology found that most patients required subsequent face-toface clinical encounters. Thus, it appears that the expense and time commitment of 
34

teledermatology systems have not yet demonstrated the potential for improving access to 

care. 

Of course, rates of concordance in a vacuum, i.e., without a clinical context of how 

the patient fared, are also limited from an evidence standpoint. What we ultimately need 

to know is the patient outcome. In other words, did the teledermatology encounter at 

least provide comparable care for the patient? A corollary question that must be 

answered is whether teledermatology resulted in harm from any missed diagnoses or 

other aspects of the telemedicine situation. These questions can only be answered in 

studies of clinical outcomes, none of which were identified in this report. One study has 

been completed (personal communication, J Whited), but at the time of this writing has 

not yet been submitted for publication. In general, advocacy for an expanded role for 

teledermatology will require further studies that examine rates of missed diagnoses, 

incorrect treatments, and when the technology is insufficient to avoid in-person 

encounters. 

Most published studies of teledermatology have examined store-and-forward 

techniques, with relatively few studies of real-time office-based techniques. Despite its 

current widespread use, additional evidence is required to conclude that store-andforward teledermatology can be routinely substituted for face-to-face encounters in the 

evaluation of new referrals to dermatologists. Dermatologic practice also involves 

follow-up visits of patients who have previously received a comprehensive dermatologic 

evaluation. Store-and-forward teledermatology may be better suited to such follow-up 

visits, but there have been no published reports of experience with this type of visit. 

Store-and-forward techniques also may be a useful adjunct in dermatologic consultations 

for settings in which patients are located a great distance from the consultant (such as 

isolated rural settings). The published studies suggest that a fraction of such patients may 

successfully avoid face-to-face visits to complete the dermatologic evaluation. 

Teleophthalmology has been widely studied, and this field has produced commercial 

systems for retinal photographs that are becoming widely used as a clinical tool to 

augment face-to-face evaluations of patients at risk for diabetic retinopathy.73 The 

quality of studies in this domain is slightly higher than in dermatology, although the 

results are equivocal. Essentially, teleophthalmology results in high rates of diagnostic 

concordance and accuracy for only some eye conditions. It appears to be most 

efficacious for the assessment of diabetic retinopathy. However, there are a number of 

diagnoses for which it fares less well, and it is often unusable altogether when certain 

patient characteristics are present, such as cataracts and other lens abnormalities. The 

value of a technology that is only useful for some conditions must be assessed in the 

larger picture of clinical outcomes and ultimately the economics of investing in 

equipment that is not always useful. 

Also widely studied is the use of telemedicine for wound care. The key observation 

from studies assessing telemedicine for this purpose is that all of the studies have small 

sample sizes, use only one assessor, and do not compare in-person examiners when 

assessing concordance. These studies present a trend of comparability, but serious 

questions remain about their statistical power and reproducibility. 

The situation of gynecology, in particular telecolposcopy, is also instructive. Studies 

show that the accuracy of diagnosis by telemedicine is comparable to face-to-face 
35

assessment. However, the accuracy of neither of these approaches is terribly efficacious, 

in the range of 50-60 percent. 

An often-touted benefit of telemedicine is the provision of care to rural areas, where 

specialists are less prevalent and individuals in need of them must travel great distances 

to see them. Studies of rural populations have tended to be of poorer methodological 

quality than studies of urban and suburban populations. The limited evidence available 

supports the use of office/hospital-based telemedicine for providing continuity care of 

stable patients by specialists. The technological platform for such systems is relatively 

uncomplicated and can be based on widely available teleconferencing equipment. 

In general, the role of telemedicine most likely to demonstrate value could be as an 

adjunct to care that is centered around the in-person visit. As noted above, it could, for 

example, serve as a means to triage skin lesions, injuries, and other problems that arise 

where appropriate specialty care is not available. In most instances, clinical care will 

likely still require in-person diagnosis and management. Likewise, telemedicine may 

also play a role in managing the growing number of elderly and other infirmed 

individuals with chronic diseases. Its value may not be as a substitute for in-person care 

as much as an adjunct to it. 

Experience with telemedicine has similarities to other attempts to apply computer 

technology to clinical environments. Computer-based expert systems went through a 

long period of experimental evaluation and limited deployment, and systems designed to 

enhance (or even replace) clinician judgment were found to be best suited to narrow 

clinical domains.74-76 Nevertheless, the use of computer-based decision support has 

steadily increased, as it has been more appropriately integrated into the clinical care 

process, serving more as an assistant than a replacement of clinical judgment and 

expertise.77 Well-designed and definitive clinical trials of this type of decision support 

have enhanced the adoption of the technology.78,79

As noted in Chapter 1, this review is limited in scope to the peer-reviewed literature 

of telemedicine. While this spectrum of data does not cover all or even most of the 

experience with telemedicine, it does provide the most objective, evidence-based 

assessment of this technology. The presence of a small number of well-designed studies 

with positive outcomes that our analysis identified shows that it is possible to 

demonstrate efficacy of telemedicine. 

Of course, there may be situations when the use of telemedicine is warranted even if 

the evidence is lacking. For example, there may be situations when care would be 

otherwise impossible to deliver except via telemedicine. This could include remote rural 

areas or other locations where medical care is not available locally and the patient is for 

whatever reason unable to travel to a setting where it can be obtained. However, even in 

these instances it is important to understand the efficacy of telemedicine so any clinical 

shortcomings can be anticipated. We are reassured that no studies show telemedicine to 

cause any significant harm. 

We also acknowledge that the efficacy of telemedicine is not immune to other forces 

in health care, such as the structure of the delivery system. There are instances when 

reimbursement or other incentives are not amenable to innovations, technical or 

otherwise. In particular, fee-for-service health care will likely provide incentive for 

modalities of care that are reimbursed, not necessarily those that provide the best quality 
36

care. Therefore it will be important for ongoing research to take into account the health 

care setting when evaluating the efficacy of telemedicine. 

Future Research 

The present evidence base provides guidance on the clinical areas in which future 

research is most likely to be useful. It now is clear that continued small or 

methodologically weak studies are unlikely to add to the evidence base for telemedicine. 

In teledermatology, larger and more comprehensive analyses that assess key patient 

outcomes are needed. Likewise, there is a need for similar studies of clinical outcomes 

using office/hospital-based telemedicine in fields such as psychiatry and neurology. 

Well-designed RCTs will likely provide valuable information on the potential of these 

clinical applications. Longitudinal observational studies and demonstration projects also 

will be useful. Studies of home-based telemedicine should carefully address the 

independent contributions of technology and human resources in the complex delivery 

models for patients with chronic diseases. 

We recognize the limitations of advice that telemedicine be studied with more and 

larger RCTs. Not only are such trials expensive, but they are difficult to carry out. They 

also have a long lead-time from their planning and inception to completion and analysis 

of results. Another challenge with RCTs in this area is that telemedicine is not a single 

technology or intervention. It is a tool that is used to deliver different aspects of clinical 

care for diverse diseases. Due to the time and expense of RCTs, other means to assess 

telemedicine interventions objectively should also be explored. Given the growing use of 

electronic health records, selective data could be extracted on patients with telemedicine 

interventions to assess them longitudinally. Such studies will be most feasible in large 

integrated delivery networks with advanced electronic health record systems. 

This report has found that the evidence base for telemedicine is incomplete yet 

improving. Further well-designed and targeted research that provides high-quality data 

will provide a strong contribution to understanding how best to deploy technological 

resources in health care. 

Conclusion 

 The promise of telemedicine is not matched by the strength of its evidence base. 

The technology to administer telemedicine is prevalent and, in some locations, 

ubiquitous. Telemedicine is widely used, with increasing numbers of health care payers 

reimbursing for its use. However, outside of a small number of clinical specialties, the 

evidence base for the efficacy of telemedicine is weak. Areas where telemedicine is most 

promising include home health and specialties where care can be delivered via interactive 

videoconferencing, such as psychiatry and neurology. There is mixed evidence for the 

efficacy of telemedicine in dermatology and ophthalmology. Further research must 

address the limited evidence base so that the optimal use of telemedicine can be 

ascertained. 
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51. Harvey-Berino J, Pintauro SJ, and Gold EC. The 

feasibility of using Internet support for the 

maintenance of weight loss. Behav Modif 2002

Jan;26(1):103-16. 

52. Mullan B, Snyder M, Lindgren B, et al. Home 

monitoring for lung transplant candidates. Prog 

Transplant 2003 Sep;13(3):176-82. 

53. Bowman RJ, Kennedy C, Kirwan JF, et al.

Reliability of telemedicine for diagnosing and

managing eye problems in accident and emergency 

departments. Eye 2003 Aug;17(6):743-6. 

54. Crowston JG, Kirwan JF, Wells A, et al. 

Evaluating clinical signs in trabeculectomized eyes.

Eye 2004 Mar;18(3):299-303. 

55. Craig J, Chua R, Wootton R, et al. A pilot study of 

telemedicine for new neurological outpatient referrals.

J Telemed Telecare 2000 6(4):225-8. 

56. Craig J, Patterson V, Russell C, et al. Interactive 

videoconsultation is a feasible method for neurological 

in-patient assessment. European Journal of Neurology

2000 7(6):699-702. 

57. Handschu R, Littmann R, Reulbach U, et al. 

Telemedicine in emergency evaluation of acute stroke: 

interrater agreement in remote video examination with 

a novel multimedia system. Stroke 2003 

Dec;34(12):2842-6. 

58. Wang S, Lee SB, Pardue C, et al. Remote

evaluation of acute ischemic stroke: reliability of 

National Institutes of Health Stroke Scale via 

telestroke.[see comment]. Stroke 2003 

Oct;34(10):e188-91. 

59. Menon AS, Kondapavalru P, Krishna P, et al. 

Evaluation of a portable low cost videophone system 

in the assessment of depressive symptoms and 

cognitive function in elderly medically ill veterans. J 

Nerv Ment Dis 2001 Jun;189(6):399-401. 

60. Yoshino A, Shigemura J, Kobayashi Y, et al. 

Telepsychiatry: assessment of televideo psychiatric 

interview reliability with present- and next-generation

internet infrastructures. Acta Psychiatr Scand 2001 

Sep;104(3):223-6. 

61. Shores MM, Ryan-Dykes P, Williams RM, et al. 

Identifying undiagnosed dementia in residential care 

veterans: comparing telemedicine to in-person clinical

examination. Int J Geriatr Psychiatry 2004

Feb;19(2):101-8. 

62. Nordal EJ, Moseng D, Kvammen B, et al. A 

comparative study of teleconsultations versus face-toface consultations. J Telemed Telecare 2001 7(5):257-

65. 

63. Leggett P, Graham L, Steele K, et al. 

Telerheumatology--diagnostic accuracy and 

acceptability to patient, specialist, and general 

practitioner. Br J Gen Pract 2001 Sep;51(470):746-8. 

64. Endean ED, Mallon LI, Minion DJ, et al. 

Telemedicine in vascular surgery: does it work? Am 

Surg 2001 Apr;67(4):334-40; discussion 340-1. 

65. Mashima PA, Birkmire-Peters DP, Syms MJ, et al. 

Telehealth: voice therapy using telecommunications 

technology. Am J Speech Lang Pathol 2003 

Nov;12(4):432-9. 

66. Ruskin PE, Silver-Aylaian M, Kling MA, et al. 

Treatment outcomes in depression: comparison of

remote treatment through telepsychiatry to in-person 

treatment. Am J Psychiatry 2004 Aug;161(8):1471-6. 

67. Woods KF, Johnson JA, Kutlar A, et al. Sickle cell 

disease telemedicine network for rural outreach. J 

Telemed Telecare 2000 6(5):285-90. 

68. Kennedy C and Yellowlees P. The effectiveness of 

telepsychiatry measured using the Health of the 

Nation Outcome Scale and the Mental Health

Inventory. J Telemed Telecare 2003 9(1):12-6. 

69. Chua R, Craig J, Esmonde T, et al. Telemedicine 

for new neurological outpatients: putting a randomized 

controlled trial in the context of everyday practice. J 

Telemed Telecare 2002 8(5):270-3. 

70. Wallace P, Haines A, Harrison R, et al. Joint 

teleconsultations (virtual outreach) versus standard

outpatient appointments for patients referred by their 

general practitioner for a specialist opinion: a

randomised trial.[see comment]. Lancet 2002 Jun

8;359(9322):1961-8. 

71. Vuolio S, Winblad I, Ohinmaa A, et al. 

Videoconferencing for orthopaedic outpatients: oneyear follow-up. J Telemed Telecare 2003 9(1):8-11. 

72. LaMonte MP, Bahouth MN, Hu P, et al. 

Telemedicine for acute stroke: triumphs and pitfalls.

Stroke 2003 Mar;34(3):725-8. 

73. Cavallerano AA, Cavallerano JD, Katalinic P, et

al. Use of Joslin Vision Network digital-video 

nonmydriatic retinal imaging to assess diabetic 

retinopathy in a clinical program. Retina 2003 

Apr;23(2):215-23. 

74. Yu VL, Fagan LM, Wraith SM, et al.

Antimicrobial selection by a computer. A blinded

3
evaluation by infectious diseases experts. Jama 1979 

Sep. 21;242(12):1279-82. 

75. Miller RA, Pople HE, Jr., and Myers JD. Internist1, an experimental computer-based diagnostic 

consultant for general internal medicine. N Engl J 

Med 1982 Aug. 19;307(8):468-76. 

76. Miller RA and Masarie FE, Jr. The demise of the 

"Greek Oracle" model for medical diagnostic systems.

Methods Inf Med 1990 Jan.;29(1):1-2. 

77. Bates DW, Cohen M, Leape LL, et al. Reducing 

the frequency of errors in medicine using information 

technology.[see comment]. JAMIA 2001 8(8):299-

308. 

Other Included Studies 

Ades PA, Pashkow FJ, Fletcher G, et al. A controlled

trial of cardiac rehabilitation in the home setting using 

electrocardiographic and voice transtelephonic 

monitoring. American Heart Journal 2000 139(3):543-

8. 

Artinian NT, Washington OG, Templin TN. Effects of 

home telemonitoring and community-based

monitoring on blood pressure control in urban African

Americans: a pilot study. Heart Lung 2001 MayJun;30(3):191-9. 

Bondmass M, Bolger N, Castro G, et al. The Effect of 

Home Monitoring and Telemanagement on Blood 

Pressure Control Among African Americans. 

Telemedicine Journal 2000 6(1):15-23. 

Bouchard S, Paquin B, Payeur R, et al. Delivering

cognitive-behavior therapy for panic disorder with 

agoraphobia in videoconference. Telemed J E Health

2004 Spring;10(1):13-25. 

Braun RP, Vecchietti JL, Thomas L, et al. Telemedical

wound care using a new generation of mobile 

telephones: a feasibility study. Arch Dermatol 2005 

Feb;141(2):254-8. 

Breslow MJ, Rosenfeld BA, Doerfler M, et al. Effect

of a multiple-site intensive care unit telemedicine

program on clinical and economic outcomes: an

alternative paradigm for intensivist staffing.[see

comment]. Crit Care Med 2004 Jan;32(1):31-8. 

Chua R, Craig J, Wootton R, et al. Randomised 

controlled trial of telemedicine for new neurological 

outpatient referrals. J Neurol Neurosurg Psychiatry

2001 Jul;71(1):63-6. 

78. Ghandi T, Bates D. Computer adverse drug event 

(ADE) detection and alerts. In: Making Health Care 

Safer: A Critical Analysis of Patient Safety Practices. 

Evidence Report Technology Assessment No. 43. 

Rockville, MD: U.S. Department of Health and

Human Services, Agency for Health Care Policy and 

Research; 2001 July. AHRQ Publication No. 01-E058. 

79. Kaushal R, Bates D. Computerized physician order

entry (CPOE) with clinical decision support systems 

(CDSSs). In: Making Health Care Safer: A Critical 

Analysis of Patient Safety Practices. Evidence Report 

Technology Assessment No. 43. Rockville, MD: U.S. 

Department of Health and Human Services, Agency

for Health Care Policy and Research; 2001 July. 

AHRQ Publication No. 01-E058. 

D'Souza R. Improving treatment adherence and

longitudinal outcomes in patients with a serious 

mental illness by using telemedicine. J Telemed

Telecare 2002 8(Suppl 2):113-5. 

Dawson E, Kennedy C, Bentley C, et al. The role of 

telemedicine in the assessment of strabismus. J 

Telemed Telecare 2002 8(1):52-5.

de Lusignan S, Wells S, Johnson P, et al. Compliance 

and effectiveness of 1 year's home telemonitoring. The 

report of a pilot study of patients with chronic heart 

failure. Eur J Heart Fail 2001 Dec;3(6):723-30. 

Egner A, Phillips VL, Vora R, et al. Depression, 

fatigue, and health-related quality of life among 

people with advanced multiple sclerosis: results from

an exploratory telerehabilitation study. 

NeuroRehabilitation 2003 18(2):125-33. 

Etherington IJ. Telecolposcopy - a feasibility study in 

primary care. J Telemed Telecare 2002 8(Suppl 2):22-

4. 

Gardner SE, Frantz RA, Specht JK, et al. How 

accurate are chronic wound assessments using 

interactive video technology? J Gerontol Nurs 2001 

Jan;27(1):15-20; quiz 52-3. 

Givens GD, Elangovan S. Internet application to teleaudiology--"nothin' but net". Am J Audiol 2003

Dec;12(2):59-65. 

Halstead LS, Dang T, Elrod M, et al. Teleassessment 

compared with live assessment of pressure ulcers in a 

wound clinic: a pilot study. Adv Skin Wound Care

2003 Mar-Apr;16(2):91-6. 

Haukipuro K, Ohinmaa A, Winblad I, et al. The

feasibility of telemedicine for orthopaedic outpatient 

4
clinics--a randomized controlled trial. J Telemed 

Telecare 2000 6(4):193-8. 

Houghton PE, Kincaid CB, Campbell KE, et al. 

Photographic assessment of the appearance of chronic 

pressure and leg ulcers. Ostomy Wound Management 

2000 46(4):20-6.

Jenkins RL, McSweeney M. Assessing elderly patients

with congestive heart failure via in-home interactive 

telecommunication. J Gerontol Nurs 2001 

Jan;27(1):21-7. 

Jerant AF, Azari R, Martinez C, et al. A randomized 

trial of telenursing to reduce hospitalization for heart

failure: patient-centered outcomes and nursing

indicators. Home Health Care Serv Q 2003 22(1):1-

20. 

Jolliffe VM, Harris DW, Whittaker SJ. Can we safely

diagnose pigmented lesions from stored video images?

A diagnostic comparison between clinical examination

and stored video images of pigmented lesions

removed for histology. Clin Exp Dermatol 2001

Jan;26(1):84-7. 

Jones OC, Wilson DI, Andrews S. The reliability of 

digital images when used to assess burn wounds. J 

Telemed Telecare 2003 9(Suppl 1):S22-4. 

Jones SM, Milroy C, Pickford MA. Telemedicine in 

acute plastic surgical trauma and burns. Ann R Coll 

Surg Engl 2004 Jul;86(4):239-42. 

Kim CY, Etemad B, Glenn TF, et al. Remote clinical

assessment of gastrointestinal endoscopy (teleendoscopy): an initial experience. Proceedings / 

AMIA ... Annual Symposium 2000 

LaFramboise LM, Todero CM, Zimmerman L, et al.

Comparison of Health Buddy with traditional 

approaches to heart failure management. Fam 

Community Health 2003 Oct-Dec;26(4):275-88. 

Mallett RB. Teledermatology in practice. Clin Exp 

Dermatol 2003 Jul;28(4):356-9.

Morlion B, Knoop C, Paiva M, et al. Internet-based 

home monitoring of pulmonary function after lung

transplantation. Am J Respir Crit Care Med 2002 Mar 

1;165(5):694-7. 

Patricoski C, Kokesh J, Ferguson AS, et al. A 

comparison of in-person examination and video 

otoscope imaging for tympanostomy tube follow-up. 

Telemed J E Health 2003 Winter;9(4):331-44. 

Rayner S, Beaconsfield M, Kennedy C, et al.

Subspecialty adnexal ophthalmological examination 

using telemedicine. J Telemed Telecare 2001 7(Suppl 

1):29-31. 

Roth A, Kajiloti I, Elkayam I, et al. Telecardiology for 

patients with chronic heart failure: the 'SHL' 

experience in Israel. Int J Cardiol 2004 Oct;97(1):49-

55. 

Russell TG, Jull GA, Wootton R. Can the Internet be 

used as a medium to evaluate knee angle? Manual 

Ther 2003 Nov;8(4):242-6. 

Scalvini S, Zanelli E, Conti C, et al. Assessment of 

prehospital chest pain using telecardiology. J Telemed 

Telecare 2002 8(4):231-6. 

Smith LF, Bainbridge J, Burns J, et al. Evaluation of 

telemedicine for slit lamp examination of the eye

following cataract surgery. Br J Ophthalmol 2003 

Apr;87(4):502-3.

Taylor P, Kennedy C, Murdoch I, et al. Assessment of 

benefit in tele-ophthalmology using a consensus panel. 

J Telemed Telecare 2003 9(3):140-5. 

Terkelsen CJ, Norgaard BL, Lassen JF, et al. 

Telemedicine used for remote prehospital diagnosing 

in patients suspected of acute myocardial infarction. J

Intern Med 2002 Nov;252(5):412-20. 

Ullah R, Gilliland D, Adams D. Otolaryngology

consultations by real-time telemedicine. Ulster Med J 

2002 May;71(1):26-9. 

Wilbright WA, Birke JA, Patout CA, et al. The use of 

telemedicine in the management of diabetes-related 

foot ulceration: a pilot study. Adv Skin Wound Care 

2004 Jun;17(5 Pt 1):232-8.

Wildi SM, Kim CY, Glenn TF, et al. Tele-endoscopy: 

a way to provide diagnostic quality for remote

populations. Gastrointest Endosc 2004 Jan;59(1):38-

43. 

Yogesan K, Constable IJ, Barry CJ, et al. 

Telemedicine screening of diabetic retinopathy using a 

hand-held fundus camera. Telemedicine Journal 2000 

6(2):219-23. 

5
A-1 

Appendix A: Exact Search Strings 

Database: Ovid MEDLINE(R) Version: re l9.2.0 

1 exp TELEMEDICINE 

2 telemedicine.mp. 

3 telehealth.mp. 

4 remote consultation$.mp. 

5 1 or 2 or 3 or 4 

6 exp Home Care Services 

7 Home Nursing 

8 6 or 7 

9 exp Therapy, Computer-Assisted 

10 exp COMPUTERS 

11 exp Computer Communication Networks 

12 exp Medical Informatics 

13 exp TELECOMMUNICATIONS 

14 exp Monitoring, Physiologic 

15 monitor$.mp. 

16 blood glucose self-monitoring 

17 Self-Examination 

18 self exam$.mp. 

19 self monitor$.mp. 

20 self test$.mp. 

21 14 or 15 or 16 or 17 or 18 or 19 or 20 

22 tele$.mp. 

23 (remote or offsite or distance).mp. 

24 Rural Population 

25 Rural Health Services 

26 HOSPITALS, RURAL 

27 rural.mp. 

28 22 or 23 or 24 or 25 or 26 or 27 

29 21 and 28 

30 9 or 10 or 11 or 12 or 13 or 29 

31 8 and 30 

32 31 not 5 

33 limit 32 to english language 

34 32 not 33 

35 limit 34 to abstracts 

36 33 or 35 

37 5 or 36 

38 limit 37 to yr=2000-2004 

39 exp Computer Communication Networks 

40 Patient Participation 

41 exp Consumer Satisfaction
A-2 

42 "Delivery of Health Care" 

43 exp Home Care Services 

44 exp Home Nursing 

45 house calls/ or house call$.mp. or housecall$.mp. 

46 40 or 41 or 42 or 43 or 44 or 45 

47 39 and 46 

48 limit 47 to english language 

49 limit 48 to yr=2000-2004 

50 38 or 49 
A-3

Appendix B. Sample Data Abstraction Forms 

Store-and-forward telemedicine: 

1. Sample data abstraction form for studies of diagnosis and management for store-and-forward 

telemedicine 

Source Specialty Purpose Gold 

standard 

Sample Diagnosis (D) 

and/or 

management (M) 

decisions 

Limitations Study 

Class 

 

2. Sample data abstraction form for studies of access for store-and-forward telemedicine 

Source Purpose/ 

design 

Intervention Control Measure of 

access 

Population/ 

sample 

Results Limitations Study 

Class 

 

Home-based telemedicine: 

3. Sample data abstraction form for studies of diagnosis and management for home-based telemedicine 

Source Domain Purpose Gold 

standard 

Sample Diagnosis (D) 

and/or 

management (M) 

decisions 

Limitations Study 

Class 

 

4. Sample data abstraction form for studies of health outcomes for home-based telemedicine

Source Domain Question Study 

type 

Control Sample Results Limitations Study 

Class 

 

Office/hospital-based telemedicine 

5. Sample data abstraction form for studies of diagnosis and management for office/hospital-based 

telemedicine

Source Specialty Purpose Gold 

standard 

Sample Diagnosis (D) 

and/or 

management (M) 

decisions 

Limitations Study 

Class 

 

6. Sample data abstraction form for studies of access for office/hospital-based telemedicine 

Source Purpose/ 

design 

Intervention Control Measure of 

access 

Population/ 

sample 

Results Limitations Study 

Class 

 

7. Sample data abstraction form for studies of health outcomes for office/hospital-based telemedicine 

Source Specialty Question Study 

type 

Control Sample Results Limitations Study 

Class 

 
A-4 

Appendix C. Evidence Tables 

Evidence table 1: Studies of diagnosis and management for store-and-forward 

telemedicine........................................................................................A-5 

Evidence table 2: Studies of access for store-and-forward telemedicine.................A-12 

Evidence table 3: Studies of diagnosis and management for home-based telemedicine 

......................................................................................................A-14 

Evidence table 4: Studies of health outcomes for home-based telemedicine............A-15 

Evidence table 5: Studies of diagnosis and management for office/hospital-based 

telemedicine.......................................................................................A-21 

Evidence table 6: Studies of health outcomes for office/hospital-based telemedicine..A-25 

Evidence table 7: Studies of access for office/hospital-based telemedicine..............A-27 

Listing of included studies......................................................................A-33 
Evidence table 1: Studies of diagnosis and management for store-and-forward telemedicine 

Source Specialty Purpose Sample Number 

of TM clinicians 

Diagnosis or Management 

Concordance FTF v FTF 

concorda

Barnard, 2000 

Dermatology Diagnostic 

agreement in all patients; accuracy of diagnosis in those with definitive diagnostic test 

50 cases, 25 confirmed by dx testing 

8 Both For 50 cases, 77% 

(range 67-84%) for primary dx and 90% (range 84-96%) for diff dx; decision to biopsy 40% for FTF vs. 45% for TM 

No 

Coras, 2003 

Dermatology Diagnostic 

agreement of teledermatoscopy 

100 cases of pigmented lesions using teledermatoscopy, 45% of which were biopsied 

3 Diagnosis 

DuMoulin, 2003 

Dermatology Diagnostic 

agreement for TM 

106 cases referred by GP 

1 Diagnosis 54% full 

agreement, 9% partial agreement (diff dx), and 37% no agreement 

No 

Eminovic, 2003 

Dermatology Diagnostic 

agreement for patients seen via TM vs. FTF 

96 cases referred by GP 

12 Diagnosis 41% full 

agreement, 10% partial agreement (diff dx), and 49% no agreement 

No 

Jolliffe, 2001, BJD 

Dermatology Decision by GP 

to triage pigmented lesions for TM assessment 

819 lesions assessed for referral 

5 Management For decision to 

refer, sens = 88% and spec = 66%; intraobserver kappa = 0.48 

No 

C-1
Evidence table 1: Studies of diagnosis and management for store-and-forward telemedicine (continued)

Source Specialty Purpose Sample Number 

of TM clinicians 

Diagnosis or Management 

Concordance FTF v FTF 

concorda

Jolliffe, 2001, CED 

Dermatology Comparison of 

pigmented lesions diagnosed by TM vs. FTF 

144 lesions assessed histologically 

NS Diagnosis 

Lim, 2001 Dermatology Diagnostic 

agreement for TM for primary and diff dx 

53 cases from 49 patients 

4 Diagnosis Self concordance 

vs. FTF 88%; concordance for 4 other derms 79% (range 73-85%) 

No 

Oztas, 2003 Dermatology Diagnostic 

agreement for TM with pictures alone and clinical information added 

125 patients referred 

3 Diagnosis Agreement of TM 

was 55-58% without clinical information, 69-87% with clinical information 

No 

Pak, 2003 (2 studies) 

Dermatology Intraobserver 

diagnostic agreement for TM 

404 patients referred 

1 Both Intraobserver (TM 

followed by FTF) agreement was 70% complete, 20.6% partial, and 9.4% none; for partial or no agreement, clinical significance was moderate 41.3% and severe 0.8%; biopsy rates false positive 17.1% and false negative 6.9% 

No 

C-2 
Evidence table 1: Studies of diagnosis and management for store-and-forward telemedicine (continued)

Source Specialty Purpose Sample Number 

of TM clinicians 

Diagnosis or Management 

Concordance FTF v FTF 

concorda

Piccolo, 2002 

Dermatology Diagnostic 

agreement with teledermoscopy 

43 cases of pigmented lesions 

8 Diagnosis 

Rashid, 2003 

Dermatology Diagnostic 

agreement for TM 

26 skin conditions in 33 patients 

1 Diagnosis 81% agreement 

and 19% disagreement 

No 

Shapiro, 2004 

Dermatology Decision to 

perform a skin biopsy by FTF dermatologist 

49 patients with pigmented lesions 

1 Management 100% agreement 

on decision to biopsy 

No 

Taylor, 2001 

Dermatology Agreement for 

TM diagnosis and decision to make referral 

194 patients assessed 13 months after actual visit 

2 Diagnosis Agreement of TM 

was 77%; no difference between intra and interobserver 

No 

Kim, 2000 Gastroenterology Accuracy of GI 

endoscopy transmitted by video 

5 patients for upper GI endoscopy, 5 patients for lower GI endoscopy – observed by TM 

1 Diagnosis 100% agreement 

on all diagnoses but G-E junction not seen clearly on 2 upper GI endoscopies 

No 

Wildi, 2004 Gastroenterology Diagnostic quality 

of remote GI endoscopy 

50 patients undergoing GI endoscopy 

1 Diagnosis 

C-3
Evidence table 1: Studies of diagnosis and management for store-and-forward telemedicine (continued)

Source Specialty Purpose Sample Number 

of TM clinicians 

Diagnosis or Management 

Concordance FTF v FTF 

concorda

Etherington, 2002 

Gynecology Diagnostic 

agreement in telecolposcopy 

81 women undergoing colopscopy 

1 Diagnosis For normal vs. 

abnormal, 91.4% agreement; for normal vs. lowgrade CIN vs. high-grade CN, 79.0% agreement 

No 

Ferris, 2002, OG 

Gynecology Diagnostic 

agreement in telecolposcopy 

186 women undergoing cervical biopsy after colposcopy (also interactive) 

2 Both Agreement for 

biopsy was 67.4% for site experts vs. interactive TM, 73.3% for local vs. site experts, 84.1% for local vs. interactive TM, and 72.6 for TM vs. S&F TM, comparable to decisions for endocervical curettage 

Yes 

Ferris, 2002, JFP 

Gynecology Sensitivity of 

telecolposcopy and remote cervicography 

264 women undergoing cervical biopsy after colposcopy 

3 Diagnosis 

C-4
Evidence table 1: Studies of diagnosis and management for store-and-forward telemedicine (continued)

Source Specialty Purpose Sample Number 

of TM clinicians 

Diagnosis or Management 

Concordance FTF v FTF 

concorda

Baker, 2004 Ophthalmology Accuracy of 

different levels of JPEG compression for findings and management decisions in diabetic retinopathy (DR) 

20 diabetic patients with images compressed 55x and 113x 

1 Diagnosis Agreement varied 

for retinal abnormalities from kappa = 0.45-1.0, for level of retinopathy from 0.73-1.0, and for management recommendation follow-up from 0.64-1.0 

No 

GomezUlla, 2002 Ophthalmology Agreement in detection and 

grading of DR 

126 eyes in 70 diabetic patients assessed for DR 

1 Diagnosis 

Saari, 2004 Ophthalmology Agreement in 

grading DR 

70 diabetic patients and controls assessed with various digital photography and handheld digital video (DV) camera 

3 Diagnosis 

Shiba, 2002 Ophthalmology Accuracy of 

fundus photography for DR 

61 diabetic patients assessed with digital photography for DR 

1 Diagnosis 

C-5
Evidence table 1: Studies of diagnosis and management for store-and-forward telemedicine (continued)

Source Specialty Purpose Sample Number 

of TM clinicians 

Diagnosis or Management 

Concordance FTF v FTF 

concorda

Yogesan, 2000 

Ophthalmology Agreement in TM 

screening 

43 subjects assessed with digital indirect ophthalmoscope (DIO) and handheld fundus camera (HFC) vs. stereo fundus camera (gold standard) 

1 Diagnosis Correlation 

coefficient for DIO vs. gold standard was 0.80 and for HFC vs. gold standard was 0.76 

No 

Braun, 2005 

Wound Care Wound 

assessment using new generation mobile telephone cameras 

61 wounds in 52 patients 

3 Diagnosis Agreement vs. 

FTF varied from kappa = 0.74-0.82 for TM physicians 

No 

Gardner, 2001 

Wound Care Accuracy of 

chronic wound assessments 

13 wound observations 

1 Diagnosis Agreement on 8 

characteristics was 75-100% but only 54% on presence of epithelial tissue 

No 

Halstead, 2003 

Wound Care Management 

decisions in wound care for 4 yes/no decisions 

17 individuals with 20 wounds 

1 Management Agreement on 

management decisions averaged 89% 

No 

Houghton, 2000 

Wound Care Correlation of 

wounds assessed by pressure sore status tool (PSST) and photographs 

Assessment of photographic wound assessment tool (PWAT) in 137 skin ulcers 

3 Diagnosis Intra-rater 

correlation on PWAT score was 96% and interrater correlation was 73% 

No 

C-6 
Evidence table 1: Studies of diagnosis and management for store-and-forward telemedicine (continued)

Source Specialty Purpose Sample Number 

of TM clinicians 

Diagnosis or Management 

Concordance FTF v FTF 

concorda

Jones, 2003 

Wound Care Reliability of 

images to assess burn wounds 

60 burn wounds assessed with different resolution digital photographs 

1 Diagnosis Intraobserver 

kappa was 0.53-0.60 

No 

Jones, 2004 

Wound Care Agreement of 

injury severity and operative priority in minor injuries requiring plastic surgery consultation 

82 trauma referrals 

3 Both Correlation for 

grade of injury 0.78-0.81 and for operative priority 0.87-0.93 

No 

Kim, 2003 Wound Care Accuracy of 

chronic wound assessments 

430 visits on 70 patients 

NS Diagnosis Agreement for not 

healing was 67.1%, necrosis 77.0%, cellulitis 88.8%, osteomyelitis 72.5%, and not closed 96.7% 

No 

C-7 
Evidence table 2: Studies of access for store-and-forward telemedicine 

Source Purpose/ 

Design 

Intervention Control Measure of 

access 

Population/ sample 

Results Limita

Whited, 2002 Evaluate system 

for screening dermatology referrals in a VA medical center Randomized trial of consecutive routine patient referrals 

Digital image of skin lesion and standardized patient history 

Textbased referral request 

Time (in days) to definitive evaluation of skin problem 

Primary care adult patients; mean age 61.3 years N = 275 

Median time was 41 days in teledermatology group and 127 days in control group. 18.5% of teledermatology patients had definitive evaluation made by teledermatology. 

Dermahad a appointhat likthe difbetwe

Mallett, 2003 Evaluate 

teledermatology system for referrals from general practitioners Prospective case series of referrals to a community dermatology clinic 

Referral letter and digital photographs submitted by electronic mail 

None Rate of 

subsequent face-to-face visits at dermatology clinic 

Patients seen in offices of general practitioners in UK; age range 4 months to 94 years N = 325 

A telediagnosis (based on the photographs and letter) in 48% of cases. Face-to-face appointments were made for 92% of patients, and 66% of patients were seen face-to-face. Of 99 patients for whom a telediagnosis was made, the face-toface diagnosis was the same for 95%. 

Face-tdiagnoblindeteledia

Lee, 2003 Evaluate system 

for prescreening patients for surgery by a mobile surgical team Case series 

Patient history, description of physical examination, laboratory results, and digital photographs submitted to consultant surgeons in USA by electronic mail 

None Consulting 

surgeons’ judgment of appropriateness of surgical therapy and actual completion of surgery by mobile surgical team 

Adult patients referred for consideration of surgical therapy by local providers in Kenya N= 44 

35% of referred cases were judged appropriate for surgery; all of these patients underwent the planned surgery 

Cases be surby the review evalua

C-8 
Evidence table 2: Studies of access for store-and-forward telemedicine (continued) 

Source Purpose/ 

Design 

Intervention Control Measure of 

access 

Population/ sample 

Results Limita

Jaatinen, 2002 Compare 

results of specialty consultations conducted by electronic mail between physicians or by conventional visits in specialty clinics Prospective randomized trial 

Textual information provided by general practitioner using a web site. Consultant could ask for further information by electronic mail sent to the general practitioner 

Appointment in specialty clinic 

Location of further care provided after the consultation (local clinic vs. specialty clinic) 

Adult patients (mean age 62 years) seen by general practitioners in single Finnish community; specialists located 15-95 km away N = 72 

In both the telemedicine and conventional groups, 25% of patients received follow-up care in local community. 

Generpractitcould not to randompatienpreferface-tovisit. 

Tennant, 2000 Evaluate 

system for screening patients for diabetic retinopathy Case series 

Stereoscopic digital retinal photographs of dilated eyes were obtained by a local ophthalmic photographer. Satellite link used to transmit images to urban center to undergo review by retinal specialist 

None Follow-up care 

of screened patients 

Patients with diabetes identified by general practitioners in remote Canadian community; mean age 55.4 years N = 100 

10% of patients were referred for laser photocoagulation 

No infoon preof diabthe coor prevrates oscreen

C-9 
Evidence table 3: Studies of diagnosis and management for home-based telemedicine 

Source Domain Purpose Sample Number 

of TM clinicians 

Diagnosis or management 

Concordance FTF v FTF 

concordance 

A

Jenkins, 2001 

Congestive heart failure (CHF) 

Agreement in findings of CHF patients by home health nurses 

28 home care patients with CHF 

1 Diagnosis Of 18 items assessed, 

TM more likely to claim nail color abnormality and real-time nurse more likely to detect inspiratory wheeze, ankle edema, and pedal edema 

No 

Morlion, 2002 

Pulmonary function testing (PFT) 

Agreement between home and hospital spirometry after lung transplant 

PFTs in 22 patients followed for an average of over 1 year 

0 Diagnosis S

pfoe6

C-10
Evidence table 4: Studies of health outcomes for home-based telemedicine 

Source Domain Question Study type Control Sample Results LimArtinian, 2003 CHF Does the 

medication compliance device Med-eMonitor monitoring improve care? 

RCT 9 patients with 

usual care 

9 patients with usual care plus compliance device and web-based monitoring 

No change in behaviors, walking endurance, or functional class; improvement in quality of life for monitored group. 

Smsizemonup. 

Benatar, 2003 CHF Does nurse 

telemanagement by advanced practice nurse and vital sign monitoring improve outcomes? 

RCT 108 patients 

with nurse home visit 

108 patients with transtelephonic home monitoring 

Lower rate of hospital readmission and anxiety/depression; same Minnesota Living with Heart Failure Questionnaire and self-efficacy. 

 

de Lusignan, 2001 

CHF Does home 

monitoring of vital signs and video consulting improve care? 

RCT 10 patients 

with usual care 

10 patients with home telemonitoring 

Comparable weight, blood pressure, and quality of life. 

Smsize

Jerant, 2001 CHF Does home 

videoconferencing plus electronic auscultation improve care? 

RCT 12 patients in 

usual care 

13 patients with telenursing care, 12 with usual plus telephone care 

Both telephone and telecare had fewer emergency department visits and trends to fewer hospitalizations. 

Usuteleof eeffic

LaFramboise, 2003 

CHF Does HealthBuddy 

telecommunication device improve care? 

RCT 23 patients 

with home visit, 26 with telephonic 

21 patients with Health Buddy, 20 with HB+home visit 

All groups improved selfefficacy and symptoms over time but no difference between modalities. 

Limup. 

C-11
Evidence table 4: Studies of health outcomes for home-based telemedicine (continued) 

Source Domain Question Study type Control Sample Results LimRoth, 2004 CHF Does home 

monitoring of vital signs improve care? 

Pre-post 118 patients 

before intervention 

Same 118 patients after invention 

Reduction in hospital days by two-thirds; near significant improvement in quality of life 

Predesfactthan telecouinfluoutc

Chumbler, 2004 

Chronic disease in elderly 

Does HealthBuddy, monitoring of vital signs, and videoconferencing improve cognitive and other function? 

Prospective case control 

115 casematched veterans referred from senior agencies or rehabilitation programs 

111 veterans enrolled in home telemonitoring project 

Improvements in instrumental activities of daily living and functional independence measurement scales. 

No rangrohavdiffe

Kobb, 2003 Chronic 

disease in elderly 

Does HealthBuddy, monitoring of vital signs, and videoconferencing improve cognitive and other function? 

Cohort 1120 patients 

receiving usual care 

281 patients receiving remote home care 

Remote monitoring group had reduced hospital and nursing home admissions, ER and clinic visits. 

No rangrohavdiffe

Noel, 2004 Chronic 

disease in elderly 

Does monitoring of vital signs directly into EHR improve quality of life and cognitive function? 

RCT 57 veterans 47 veterans Statistically 

significant reduction in bed days of care, urgent visits, HgbA1c, OARS cognitive status and functional level. 

Manmeashodiffe

C-12
Evidence table 4: Studies of health outcomes for home-based telemedicine (continued) 

Source Domain Question Study type Control Sample Results LimAdes, 2000 Coronary 

artery disease 

Does EKG and transtelephonic monitoring provide comparable outcomes for athome cardiac rehabilitation? 

Cohort 50 patients 

receiving usual care 

83 patients Exercise capacity, 

quality of life, and complications (none) comparable in both groups 

No rangrohavdiffe

Barnarson, 2003 

Coronary artery disease 

Does HealthyBuddy monitoring improve care? 

RCT 18 patients 

with Health Buddy asking series of questions 

17 patients with routine care 

Communication intervention group had higher selfefficacy, comparable risk factor adherence, and better functional outcomes per SF36. 

Relsmasize

Bellazzi, 2003 DM Does home 

glucose monitoring and videoconferencing improve outcomes? 

Cohort 67 users of 

diabetes telemedicine system 

62 non-users of system 

HgbA1C differences not significant but less variance in experimental group. 

No rangrohavdiffe

Biermann, 2002 

DM Does home 

glucose monitoring improve outcomes? 

RCT 16 patients 

with conventional care 

27 patients with home glucose monitoring 

Both groups had comparable drops in HgbA1C levels. 

Smsizeuneunedistgro

Izquierdo, 2003 

DM Does diabetes 

education delivered by telemedicine improve outcomes? 

RCT 22 patients 

with education delivered inperson 

24 patients with education delivered via telemedicine 

No change in HgbA1C or behavior goals between groups. 

 

C-13
Evidence table 4: Studies of health outcomes for home-based telemedicine (continued) 

Source Domain Question Study type Control Sample Results LimWelch, 2003 DM Does home 

glucose monitoring improve outcomes? 

RCT 26 patients 

who used modemequipped glucometers 

26 patients who received usual care 

Slightly larger drop in HgbA1C for experimental group but not significant 

ResobtaMonovesubfollomon

Montori, 2004 DM Does home 

glucose monitoring with feedback improve outcomes? 

RCT 16 patients 

with glucometer transmission plus nurse feedback 

15 patients with glucometer transmission but no feedback 

Statistically significant reduction in HgbA1C (8.2 vs. 7.8%), 50 more minutes per patient in phone time for experimental group 

 

Artinian, 2001 Hypertension Does home 

monitoring and community-based monitoring of blood pressure improve care? 

RCT 9 patients with 

usual care 

6 patients with home telemonitoring and 6 with communitybased monitoring 

Drop in BP for both experimental groups statistically significant over control group. 

Smsizemonup. 

Bondmass, 2000 

Hypertension Does home 

monitoring of blood pressure improve care? 

Pre-post 33 patients 

with uncontrolled hypertension >1 year 

Same 33 patients after invention 

Statistically significant reduction in blood pressure from average of 154/90 to 141/83 

Predesfactthan telecouinfluoutc

C-14
Evidence table 4: Studies of health outcomes for home-based telemedicine (continued) 

Source Domain Question Study type Control Sample Results LimRogers, 2001 Hypertension Does home 

monitoring of blood pressure improve care? 

RCT 55 patients 

with usual care 

56 patients with home telemonitoring 

Better improvement in mean, systolic, and diastolic pressure (mmHg) for home telemedicine (-2.8,-4.9,-2.0) vs. control (+1.3,-0.1,+2.1). 

Clinsignimpin bpreclea

Mullan, 2003 Lung 

transplantation 

Does monitoring by home electronic symptom diary improve outcomes in patients awaiting lung transplant? 

RCT 52 patients 

with telephone reporting 

67 patients uploading electronic diary 

Adherence, length of stay in hospital after transplant, and survival after transplant identical. 

Few parass

Egner, 2003 Multiple 

sclerosis 

Does telerehabilitation program delivered via video or phone improve care? 

RCT (subgroup analysis) 

7 patients with in-person and 11 patients with phone rehabilitation 

9 patients with video rehabilitation 

Generally equivalent scores over two years on quality of wellbeing (QWB) scale, Center for Epidemiologic Studies Depression (CESD) scale, and Fatigue Severity Scale (FSS). 

Subanalargsmasize

Phillips, 2001 Newly injured 

spinal cord patients 

Does video-based rehabilitation improve care? 

RCT 39 patients 

with standard intervention, 36 with telephone intervention 

36 patients with video intervention 

Video intervention group had significantly higher Quality of WellBeing scale at one year and reduced annual hospital days 

 

C-15
Evidence table 4: Studies of health outcomes for home-based telemedicine (continued)

Source Domain Question Study type Control Sample Results LimHarveyBerino, 2002 Obesity Does therapist-led Internet support 

group lead to better weight loss? 

RCT 15 patients in 

control group, 14 patients in therapist-led in-person group 

15 patients in therapist-led Internet group 

Amount of weight loss comparable in all groups. 

Smsize

D'Souza, 2002 Psychiatry Does a psychoeducational 

program by videoconference after inpatient discharge improve care? 

Cohort 27 patients 

discharged to conventional care 

24 patients discharged to care plus program 

Telemedicine patients had higher adherence, lower readmission, and lower medication side effects. 

No rangrohavdiffe

Maiolo, 2003 Pulmonary 

Disease 

Does home monitoring of pulmonary status of pulmonary status improve care? 

Pre-post 23 patients 

with home monitoring of pulmonary function 

Same patients after intervention 

Statistically significant reduction in hospital admissions (2.0 vs. 1.0) and acute exacerbations (1.4 vs. 0.63) 

Predesfactthan telecouinfluoutc

C-16
Evidence table 5: Studies of diagnosis and management for office/hospital-based telemedicine 

Source Specialty Purpose Sample Number 

of TM clinicians 

Diagnosis or management 

Concordance FTF v FTF 

concordanc

Scalvini, 2002 

Cardiology Remote diagnosis 

of chest pain by GP 

952 ECG diagnoses made by TM 

NS Diagnosis 

Terkelsen, 2002 

Cardiology Prehospital 

diagnosis in ambulances 

250 patients for prehospital diagnosis of acute MI 

NS Diagnosis 

Nordal, 2001 

Dermatology Agreement in 

diagnosis via videoconference 

121 patients referred to dermatologist 

2 Diagnosis Agreement was 

72% complete and 14% partial 

No 

Craig, 2000, EJN 

Neurology Agreement of 

neurologic inpatient assessment 

25 neurology inpatients 

1 Diagnosis 

Craig, 2000, JTT 

Neurology Agreement of 

neurologic outpatient assessment 

25 neurology outpatients 

1 Diagnosis 

Handschu, 2003 

Neurology Agreement of 

stroke assessment via NIH Stroke Scale (NIHSS) 

41 patients receiving NIH Stroke Scale (NIHSS) in setting of acute stroke 

NS Diagnosis Agreement on 13 

elements varied from 0.44-0.89 on unweighted kappa and from 0.85-0.99 when weighted per accepted protocol 

No 

Wang, 2003 

Neurology Accuracy of 

stroke assessment using NIH Stroke Scale (NIHSS) 

20 patients receiving NIHSS in setting of acute stroke 

4 Diagnosis Correlation of 

score for TM vs. FTF was 0.96 

No 

C-17 
Evidence table 5: Studies of diagnosis and management for office/hospital-based telemedicine (continued)

Source Specialty Purpose Sample Number 

of TM clinicians 

Diagnosis or management 

Concordance FTF v FTF 

concordanc

Bowman, 2003 

Ophthalmology Accuracy of eye 

injury assessment 

80 patients with eye injury (40 each for TM vs. FTF and FTF vs. FTF 

2 Diagnosis For TM vs. FTF, 

agreement was complete 58%, partial 37%, and not 5%. For FTF vs. FTF, agreement was complete 75%, partial 20%, and not 5%. Agreement better when slit lamp vs. ophthalmoscope used. 

Yes 

Crowston, 2004 

Ophthalmology Measurements in 

trabeculectomized eyes using telemedicine vs. in-person 

40 trabeculectomized eyes in 40 patients 

3 Diagnosis For 6 measures, 

agreement always higher in FTF vs. FTF than TM vs. FTF 

Yes 

Dawson, 2002 

Ophthalmology Assessment of 

strabismus 

30 patients with strabismus 

2 Diagnosis Agreement was 

complete 80%, partial 3%, and incomplete 17% 

No 

Rayner, 2001 

Ophthalmology Agreement of 

ophthalmic adnexal exam 

17 patients with adnexal (eye) conditions 

2 Both 58% had full 

agreement, 24% had diagnostic agreement but management disagreement, and 18% had incorrect TM diagnosis 

No 

C-18
Evidence table 5: Studies of diagnosis and management for office/hospital-based telemedicine (continued)

Source Specialty Purpose Sample Number 

of TM clinicians 

Diagnosis or management 

Concordance FTF v FTF 

concordanc

Smith, 2003 

Ophthalmology Slit lamp 

assessment via telemedicine 

12 cataract and 10 control patients 

2 Both Agreement was 

70-100% for control patients and 0-100% for cataract patients 

No 

Givens, 2003 

Otolaryngology Agreement in 

audiometry testing 

45 patients assessed with conventional and TM audiometer for air conduction, 25 of whom were also assessed for bone conduction 

NA Diagnosis Correlation was 

0.71-0.89 for different frequencies in air conduction, 0.79-0.94 for bone conduction 

NA 

Ullah, 2002 

Otolaryngology Accuracy of 

otolarynology consultation 

Intraobserver concordance for assessment of 42 patients 

1 Diagnosis 

Menon, 2001 

Psychiatry Psych 

assessment of depression and cognitive status using videophone 

Administration of GDS, HAM-D, and SPMSE to 24 elderly patients 

2 Diagnosis Coefficient of 

variation for GDS was 20.7% FTF/27.9% TM (NS), for HAM-D was 27.7% FTF/30.8% TM (NS), and for SPMSE was 63.3% FTF/31.6% TM (p=.02) 

No 

C-19
Evidence table 5: Studies of diagnosis and management for office/hospital-based telemedicine (continued)

Source Specialty Purpose Sample Number 

of TM clinicians 

Diagnosis or management 

Concordance FTF v FTF 

concordanc

Shores, 2004 

Psychiatry Neuropsychiatric 

evaluation via telemedicine 

16 patients screening positive for dementia on 7-minute screen 

NS Diagnosis 100% agreement 

on presence of dementia (in 12 patients) 

No 

Yoshino, 2001 

Psychiatry Agreement in 

Brief Psychiatric Rating Scale administration 

42 patients with chronic schizophrenia interviewed by FTF and viewed by narrowband and broadband 

NS Diagnosis Agreement was 

87% FTF vs. FTF, 88% FTF vs. broadband TM, 44% FTF vs. narrowband TM (p<.05) 

Yes 

Leggett, 2001 

Rheumatology Accuracy of 

rheumatology consultation 

100 patients referred to a rheumatologist 

1 Diagnosis 

Endean, 2001 

Vascular Surgery 

Agreement of treatment recommendations for vascular surgery patients seen via telemedicine 

64 vascular abnormalities in 32 patients 

1 Management Agreement with 

treatment recommendations was 91% 

No 

C-20
Evidence table 6: Studies of health outcomes for office/hospital-based telemedicine 

Source Specialty Question Study 

type 

Control Sample Results Limi

Breslow, 2004 

Critical Care Does supplemental 

remote ICU monitoring improve outcomes of care? 

Pre-post 1396 patients 

before telemedicine intervention 

744 patients after intervention 

Telemedicine reduced mortality (RR=0.73), length of stay (3.63 days vs. 4.35 days), and variables costs per case 

Pre-meathan could influe

Chua, 2001 Neurology Are new 

neurological referrals as effective via telemedicine as in-person as measured by number of tests, prescriptions, and disposition? 

RCT Rate of 

agreement of telemedicine vs. in-person 

76 patients evaluated by telemedicine, 65 patients evaluated by inperson care 

In-person patients had fewer neuro (6/82 vs. 26/86) and non-neuro (5/82 vs. 20/86) tests but same amount of prescriptions and discharge after first consultation. 

Focuprocclinic

Russell, 2003 

Orthopedics Does 

telerehabilitation for total knee replacement have comparable outcomes? 

RCT 11 patients 

randomized to conventional care 

10 patients who had weekly treatment for 6 weeks 

No difference in physical or functional measurements. 

Smafollow

Vuolio, 2003 

Orthopedics Is videoconferencing aided 

by GP and nurse as effective as traditional clinic? 

RCT 69 patients 

seen in outpatient clinic 

76 patients seen in health center by videoconference 

Equal fulfillment of patient management plans. 

Focuprocclinic

Mashima, 2003 

Otolarngology Can voice therapy 

be delivered as effectively by telemedicine as in person? 

RCT 28 patients 

with conventional voice therapy 

23 patients with videoconference voice therapy 

Both groups improved, with no differences between them. 

 

C-21
Evidence table 6: Studies of health outcomes for office/hospital-based telemedicine (continued)

Source Specialty Question Study 

type 

Control Sample Results Limi

Bouchard, 2004 

Psychiatry Can cognitivebehavior therapy for 

panic disorder be delivered via telemedicine? 

Cohort 11 patients 

with videoconferencing 

10 patients with face to face care 

Both groups had comparable improvement in reduction in panic attacks and scores on Beck Depression Inventory. 

Smarand

Kennedy, 2003 

Psychiatry Do patients using 

telepsychiatry have comparable health outcomes to inperson care? 

Cohort 92 patients 

who did not have telepsychiatry 

32 patients who had telepsychiatry 

No difference in Health of the Nation Outcome Scale or Mental Health Inventory. 

No ralikely betwexpecont

Ruskin, 2004 Psychiatry Is telepsychiatry 

treatment (medications, education, brief supportive counseling) comparable to face to face treatment? 

RCT 60 patients 

treated with face to face treatment 

59 patients treated with telepsychiatry 

Equal outcomes in both groups for Hamiltion Depression Rating Scale and Beck Depression Inventory. 

 

Wilbright, 2004 

Wound Care Is telemedicine 

treatment comparable to inperson treatment? 

Cohort 120 patients 

treated conventionally 

20 patients treated via interactive telemedicine 

No differences in healing time or percent healed 

No ralikely betwexpecont

C-21
Evidence table 7: Studies of access for office/hospital-based telemedicine 

Source Purpose/ 

Design 

Intervention Control Measure of 

access 

Population/ sample 

Results L

LaMonte, 2003 

Evaluate system for screening patients with symptoms of stroke seen in emergency department 100 miles from stroke treatment center Comparison of telemedicine cases to concurrent cases managed by telephone consultation 

2-way audio-video link; consultant neurologist interviews and examines stroke patient by telemedicine. 

Telephone discussion between emergency department physician and consultant neurologist. 

Percentage of patients receiving fibrinolytic therapy for acute stroke 

Patients presenting to hospital emergency department; no demographic data reported. N=50 

22% of 23 telemedicine patients received fibrinolytic therapy, compared to 4% of 27 traditional consultations 

Ancpinfith

Woods, 2000 

Evaluate system for providing follow-up care to patients with sickle cell anemia living more than 100 miles from university clinic Before/after study of clinic workload 

2-way audio-video link; consultant at university clinic interviews patient; on-site nurse assists with physical examination. 

Rural outreach clinics; consultant travels to clinic for faceto-face patient encounters. 

Annual number of patient encounters at rural sites 

Adult patients with sickle cell anemia; 84% Medicaid insurance N=128 in posttelemedicine period 

271 annual clinic visits in pretelemedicine period (1996); 745 clinic visits in posttelemedicine period (1999) 

Octep71bacovAs(paa

C-23 
Evidence table 7: Studies of access for office/hospital-based telemedicine (continued)

Source Purpose/ 

Design 

Intervention Control Measure of 

access 

Population/ sample 

Results L

Haukipuro, 2000 

Evaluate satisfaction with a system for routine orthopedic clinic visits Randomized trial of patients referred to a university orthopedic clinic in Finland 

2-way audio-video link; orthopedic specialist at university clinic interviews patient; primary care physician assists with physical examination at remote site. 

Patient travels to university clinic for faceto-face encounter 

Overall satisfaction of clinical quality of examination by orthopedic specialist 

Orthopedic patients; mean age 56.7 years. N = 145 

Overall satisfaction rated as very good or good in 80% or telemedicine encounters and 89% of conventional encounters 

Nc

Vuolio, 2003 Evaluate 

treatment plans of newly referred orthopedic patients examined via a telemedicine system Randomized trial of patients referred to a university orthopedic clinic in Finland. 

2-way audio-video link; orthopedic specialist at university clinic interviews patient; primary care physician assists with physical examination at remote site. 

Patient travels to university clinic for faceto-face encounter 

Classification of management plans formulated by physician conducting the patient evaluation. 

Orthopedic patients; mean age 56.7 years (same study subjects as reported in Haukipuro 2000) N = 145 

Management plans (including rates of planned surgical procedures) were similar in the two groups. 

Nao

C-24
Evidence table 7: Studies of access for office/hospital-based telemedicine (continued)

Source Purpose/ 

Design 

Intervention Control Measure of 

access 

Population/ sample 

Results L

Wallace, 2002 

Measure whether a telemedicine system to conduct initial specialist evaluations reduces rates of diagnostic test utilization and subsequent faceto-face encounters Randomized trial of patients referred by general practitioners to specialists in London, UK 

2-way audio-video link; both general practitioner and specialist participate in teleconference with patient. 

Face-to-face encounter between patient and specialist 

Orders for follow-up face-to-face appointments and diagnostic tests 

Patients seen in offices of general practitioners in UK; mean age 48 years N = 1939 

52% of telemedicine patients and 41% of control group patients were offered follow-up appointments. Follow-up appointment rates were higher for surgical specialty consultations that for medical specialty consultations. Telemedicine patients had fewer tests ordered. 

Nao

Leggett, 2001 

Compare telephone-based consultation to video-based methods for providing rheumatologic consultations Comparison of successive telephone and video-based consultations on same patients 

Patient interview by rheumatologist using desktop videoconferencing system 

Telephone conversation between general practitioner and rheumatologist 

Physician opinion of need to see patient faceto-face following teleconsultation 

Convenience sample of patients referred to a rheumatologist; mean age 48 years N = 100 

Rheumatologist judged that 75% of patients needed to be seen following the telephone consultation but only 6% following the videoconference. 

Orhstevsn

C-25 
Evidence table 7: Studies of access for office/hospital-based telemedicine (continued)

Source Purpose/ 

Design 

Intervention Control Measure of 

access 

Population/ sample 

Results L

Kennedy, 2003 

Compare psychiatric consultations delivered by videoconferencing to care of similar patients delivered face-to-face Non-randomized prospective control-group design 

Interview conducted by videoconferencing equipment 

Conventional evaluations in psychiatry clinic 

Mental health scales completed by clinician and patient at baseline and 12 months after initial evaluation 

Australian adults referred by general practitioner for psychiatric consultation N = 124 

Mean scores of the mental health scales improved over 12 months. No difference between groups in the mean size of the change scores. 

Tphadcca pd

C-26
Evidence table 7: Studies of access for office/hospital-based telemedicine (continued)

Source Purpose/ 

Design 

Intervention Control Measure of 

access 

Population/ sample 

Results L

Chua, 2002 Compare 

management plans of patients undergoing neurologic evaluation by teleconference or by face-to-face evaluation Prospective randomized trial of newly referred patients. Additional nonrandomized comparison of 4 other patient cohorts. 

Consulting neurologist interviewed patient and reviewed radiologic images placed on view box at telemedicine site. Physical examination conducted by assistant at the telemedicine site. 

Conventional clinic visits staffed by neurologists or general practitioners 

Percentage of patients receiving appointments for further testing or follow-up appointments 

Adult patients presenting to general practitioners with neurologic complaints (mean age 34.8 years) Randomized trial: N = 141; additional comparison groups: N = 252 

In the randomized trial, neurologists seeing patients face-to-face ordered tests for significantly fewer patients and showed no difference in the rate of follow-up appointments, when compared to the teleconsultation group. The non-randomized patients seen faceto-face by neurologists had similar rates of tests and follow-up appointments as the teleconsultation patients. The nonrandomized patients seen faceto-face by general practitioners had significantly higher rates of tests and follow-up appointments when compared to the teleconsultation patients. 

Cpgpnd

C-27
Evidence table 7: Studies of access for office/hospital-based telemedicine (continued)

Source Purpose/ 

Design 

Intervention Control Measure of 

access 

Population/ sample 

Results L

Taylor, 2003 Evaluate 

teleconsultation of South African patients having eye disease by British ophthalmologists Case series 

Local clinicians used a video slit lamp and presented case information by videoconferencing equipment 

None Judgment of 

consensus panel of ophthalmologists who conducted retrospective case reviews 

Patients seen in eye department of single South African hospital. Average age = 26 years (range 2-70) N = 90 

Teleconsultation judged to have definite effect on diagnosis in 24% and possible effect in 22%. Teleconsultation judged to have definitely improved visual health in 10% and possibly improved visual health in 53% of cases. 

Linc

C-28 
C-29

Listing of Included Studies

Ades PA, Pashkow FJ, Fletcher G, et al. A controlled 

trial of cardiac rehabilitation in the home setting using 

electrocardiographic and voice transtelephonic 

monitoring. American Heart Journal 2000 139(3):543-

8. 

Artinian NT, Washington OG, Templin TN. Effects of 

home telemonitoring and community-based 

monitoring on blood pressure control in urban African 

Americans: a pilot study. Heart Lung 2001 MayJun;30(3):191-9. 

Artinian NT, Harden JK, Kronenberg MW, et al. Pilot 

study of a Web-based compliance monitoring device 

for patients with congestive heart failure. Heart Lung 

2003 Jul-Aug;32(4):226-33. 

Baker CF, Rudnisky CJ, Tennant MT, et al. JPEG 

compression of stereoscopic digital images for the 

diagnosis of diabetic retinopathy via 

teleophthalmology. Can J Ophthalmol 2004 

Dec;39(7):746-54. 

Barnard CM, Goldyne ME. Evaluation of an 

asynchronous teleconsultation system for diagnosis of 

skin cancer and other skin diseases. Telemedicine 

Journal & E Health 2000 6(4):379-84. 

Barnason S, Zimmerman L, Nieveen J, et al. Impact of 

a home communication intervention for coronary 

artery bypass graft patients with ischemic heart failure 

on self-efficacy, coronary disease risk factor 

modification, and functioning. Heart Lung 2003 MayJun;32(3):147-58. 

Bellazzi R, Arcelloni M, Bensa G, et al. Design, 

methods, and evaluation directions of a multi-access 

service for the management of diabetes mellitus 

patients. Diabetes Technol Ther 2003 5(4):621-9. 

Benatar D, Bondmass M, Ghitelman J, et al. Outcomes 

of chronic heart failure.[see comment]. Arch Intern 

Med 2003 Feb 10;163(3):347-52. 

Biermann E, Dietrich W, Rihl J, et al. Are there time 

and cost savings by using telemanagement for patients 

on intensified insulin therapy? A randomised, 

controlled trial. Comput Methods Programs Biomed 

2002 Aug;69(2):137-46. 

Bondmass M, Bolger N, Castro G, et al. The Effect of 

Home Monitoring and Telemanagement on Blood 

Pressure Control Among African Americans. 

Telemedicine Journal 2000 6(1):15-23. 

Bouchard S, Paquin B, Payeur R, et al. Delivering 

cognitive-behavior therapy for panic disorder with 

agoraphobia in videoconference. Telemed J E Health 

2004 Spring;10(1):13-25. 

Bowman RJ, Kennedy C, Kirwan JF, et al. Reliability 

of telemedicine for diagnosing and managing eye 

problems in accident and emergency departments. Eye 

2003 Aug;17(6):743-6. 

Braun RP, Vecchietti JL, Thomas L, et al. Telemedical 

wound care using a new generation of mobile 

telephones: a feasibility study. Arch Dermatol 2005 

Feb;141(2):254-8. 

Breslow MJ, Rosenfeld BA, Doerfler M, et al. Effect 

of a multiple-site intensive care unit telemedicine 

program on clinical and economic outcomes: an 

alternative paradigm for intensivist staffing.[see 

comment]. Crit Care Med 2004 Jan;32(1):31-8. 

Chua R, Craig J, Wootton R, et al. Randomised 

controlled trial of telemedicine for new neurological 

outpatient referrals. J Neurol Neurosurg Psychiatry 

2001 Jul;71(1):63-6. 

Chua R, Craig J, Esmonde T, et al. Telemedicine for 

new neurological outpatients: putting a randomized 

controlled trial in the context of everyday practice. J 

Telemed Telecare 2002 8(5):270-3. 

Chumbler NR, Mann WC, Wu S, et al. The 

association of home-telehealth use and care 

coordination with improvement of functional and 

cognitive functioning in frail elderly men. Telemed J 

E Health 2004 Summer;10(2):129-37. 

Coras B, Glaessl A, Kinateder J, et al. 

Teledermatoscopy in daily routine--results of the first 

100 cases. Aktuelle Probl Dermatol 2003 32:207-12. 

Craig J, Chua R, Wootton R, et al. A pilot study of 

telemedicine for new neurological outpatient referrals. 

J Telemed Telecare 2000 6(4):225-8. 

Craig J, Patterson V, Russell C, et al. Interactive 

videoconsultation is a feasible method for neurological 

in-patient assessment. European Journal of Neurology 

2000 7(6):699-702. 

Crowston JG, Kirwan JF, Wells A, et al. Evaluating 

clinical signs in trabeculectomized eyes. Eye 2004 

Mar;18(3):299-303. 

D'Souza R. Improving treatment adherence and 

longitudinal outcomes in patients with a serious 

mental illness by using telemedicine. J Telemed 

Telecare 2002 8(Suppl 2):113-5. 
C-30

Dawson E, Kennedy C, Bentley C, et al. The role of 

telemedicine in the assessment of strabismus. J 

Telemed Telecare 2002 8(1):52-5. 

de Lusignan S, Wells S, Johnson P, et al. Compliance 

and effectiveness of 1 year's home telemonitoring. The 

report of a pilot study of patients with chronic heart 

failure. Eur J Heart Fail 2001 Dec;3(6):723-30. 

Du Moulin MF, Bullens-Goessens YI, Henquet CJ, et 

al. The reliability of diagnosis using store-and-forward 

teledermatology. J Telemed Telecare 2003 9(5):249-

52. 

Egner A, Phillips VL, Vora R, et al. Depression, 

fatigue, and health-related quality of life among 

people with advanced multiple sclerosis: results from 

an exploratory telerehabilitation study. 

NeuroRehabilitation 2003 18(2):125-33. 

Eminovic N, Witkamp L, Ravelli AC, et al. Potential 

effect of patient-assisted teledermatology on 

outpatient referral rates. J Telemed Telecare 2003 

9(6):321-7. 

Endean ED, Mallon LI, Minion DJ, et al. 

Telemedicine in vascular surgery: does it work? Am 

Surg 2001 Apr;67(4):334-40; discussion 340-1. 

Etherington IJ. Telecolposcopy - a feasibility study in 

primary care. J Telemed Telecare 2002 8(Suppl 2):22-

4. 

Ferris DG, Macfee MS, Miller JA, et al. The efficacy 

of telecolposcopy compared with traditional 

colposcopy. Obstet Gynecol 2002 Feb;99(2):248-54. 

Ferris DG, Litaker MS, Macfee MS, et al. Remote 

diagnosis of cervical neoplasia: 2 types of 

telecolposcopy compared with cervicography.[see 

comment]. J Fam Pract 2003 Apr;52(4):298-304. 

Gardner SE, Frantz RA, Specht JK, et al. How 

accurate are chronic wound assessments using 

interactive video technology? J Gerontol Nurs 2001 

Jan;27(1):15-20; quiz 52-3. 

Givens GD, Elangovan S. Internet application to teleaudiology--"nothin' but net". Am J Audiol 2003 

Dec;12(2):59-65. 

Gomez-Ulla F, Fernandez MI, Gonzalez F, et al. 

Digital retinal images and teleophthalmology for 

detecting and grading diabetic retinopathy.[see 

comment]. Diabetes Care 2002 Aug;25(8):1384-9. 

Halstead LS, Dang T, Elrod M, et al. Teleassessment 

compared with live assessment of pressure ulcers in a 

wound clinic: a pilot study. Adv Skin Wound Care 

2003 Mar-Apr;16(2):91-6. 

Handschu R, Littmann R, Reulbach U, et al. 

Telemedicine in emergency evaluation of acute stroke: 

interrater agreement in remote video examination with 

a novel multimedia system. Stroke 2003 

Dec;34(12):2842-6. 

Harvey-Berino J, Pintauro SJ, Gold EC. The 

feasibility of using Internet support for the 

maintenance of weight loss. Behav Modif 2002 

Jan;26(1):103-16. 

Haukipuro K, Ohinmaa A, Winblad I, et al. The 

feasibility of telemedicine for orthopaedic outpatient 

clinics--a randomized controlled trial. J Telemed 

Telecare 2000 6(4):193-8. 

Houghton PE, Kincaid CB, Campbell KE, et al. 

Photographic assessment of the appearance of chronic 

pressure and leg ulcers. Ostomy Wound Management 

2000 46(4):20-6. 

Izquierdo RE, Knudson PE, Meyer S, et al. A 

comparison of diabetes education administered 

through telemedicine versus in person. Diabetes Care 

2003 Apr;26(4):1002-7. 

Jaatinen PT, Aarnio P, Remes J, et al. Teleconsultation 

as a replacement for referral to an outpatient clinic. J 

Telemed Telecare 2002 8(2):102-6. 

Jenkins RL, McSweeney M. Assessing elderly patients 

with congestive heart failure via in-home interactive 

telecommunication. J Gerontol Nurs 2001 

Jan;27(1):21-7. 

Jerant AF, Azari R, Martinez C, et al. A randomized 

trial of telenursing to reduce hospitalization for heart 

failure: patient-centered outcomes and nursing 

indicators. Home Health Care Serv Q 2003 22(1):1-

20. 

Jolliffe VM, Harris DW, Morris R, et al. Can we use 

video images to triage pigmented lesions? Br J 

Dermatol 2001 Dec;145(6):904-10. 

Jolliffe VM, Harris DW, Whittaker SJ. Can we safely 

diagnose pigmented lesions from stored video images? 

A diagnostic comparison between clinical examination 

and stored video images of pigmented lesions 

removed for histology. Clin Exp Dermatol 2001 

Jan;26(1):84-7. 

Jones OC, Wilson DI, Andrews S. The reliability of 

digital images when used to assess burn wounds. J 

Telemed Telecare 2003 9(Suppl 1):S22-4. 

Jones SM, Milroy C, Pickford MA. Telemedicine in 

acute plastic surgical trauma and burns. Ann R Coll 

Surg Engl 2004 Jul;86(4):239-42. 

Kennedy C, Yellowlees P. The effectiveness of 

telepsychiatry measured using the Health of the
C-31

Nation Outcome Scale and the Mental Health 

Inventory. J Telemed Telecare 2003 9(1):12-6. 

Kim CY, Etemad B, Glenn TF, et al. Remote clinical 

assessment of gastrointestinal endoscopy (teleendoscopy): an initial experience. Proceedings / 

AMIA ... Annual Symposium 2000 

Kim HM, Lowery JC, Hamill JB, et al. Accuracy of a 

web-based system for monitoring chronic wounds. 

Telemed J E Health 2003 Summer;9(2):129-40. 

Kobb R, Hoffman N, Lodge R, et al. Enhancing elder 

chronic care through technology and care 

coordination: report from a pilot. Telemed J E Health 

2003 Summer;9(2):189-95. 

LaFramboise LM, Todero CM, Zimmerman L, et al. 

Comparison of Health Buddy with traditional 

approaches to heart failure management. Fam 

Community Health 2003 Oct-Dec;26(4):275-88. 

LaMonte MP, Bahouth MN, Hu P, et al. Telemedicine 

for acute stroke: triumphs and pitfalls. Stroke 2003 

Mar;34(3):725-8. 

Lee S, Broderick TJ, Haynes J, et al. The role of lowbandwidth telemedicine in surgical prescreening. J 

Pediatr Surg 2003 Sep;38(9):1281-3. 

Leggett P, Graham L, Steele K, et al. 

Telerheumatology--diagnostic accuracy and 

acceptability to patient, specialist, and general 

practitioner. Br J Gen Pract 2001 Sep;51(470):746-8. 

Lim AC, Egerton IB, See A, et al. Accuracy and 

reliability of store-and-forward teledermatology: 

preliminary results from the St George 

Teledermatology Project. Australas J Dermatol 2001 

Nov;42(4):247-51. 

Maiolo C, Mohamed EI, Fiorani CM, et al. Home 

telemonitoring for patients with severe respiratory 

illness: the Italian experience. J Telemed Telecare 

2003 9(2):67-71. 

Mallett RB. Teledermatology in practice. Clin Exp 

Dermatol 2003 Jul;28(4):356-9. 

Mashima PA, Birkmire-Peters DP, Syms MJ, et al. 

Telehealth: voice therapy using telecommunications 

technology. Am J Speech Lang Pathol 2003 

Nov;12(4):432-9. 

Menon AS, Kondapavalru P, Krishna P, et al. 

Evaluation of a portable low cost videophone system 

in the assessment of depressive symptoms and 

cognitive function in elderly medically ill veterans. J 

Nerv Ment Dis 2001 Jun;189(6):399-401. 

Montori VM, Helgemoe PK, Guyatt GH, et al. 

Telecare for patients with type 1 diabetes and 

inadequate glycemic control: a randomized controlled 

trial and meta-analysis. Diabetes Care 2004 

May;27(5):1088-94. 

Morlion B, Knoop C, Paiva M, et al. Internet-based 

home monitoring of pulmonary function after lung 

transplantation. Am J Respir Crit Care Med 2002 Mar 

1;165(5):694-7. 

Mullan B, Snyder M, Lindgren B, et al. Home 

monitoring for lung transplant candidates. Prog 

Transplant 2003 Sep;13(3):176-82. 

Noel HC, Vogel DC, Erdos JJ, et al. Home telehealth 

reduces healthcare costs. Telemed J E Health 2004 

Summer;10(2):170-83. 

Nordal EJ, Moseng D, Kvammen B, et al. A 

comparative study of teleconsultations versus face-toface consultations. J Telemed Telecare 2001 7(5):257-

65. 

Oztas MO, Calikoglu E, Baz K, et al. Reliability of 

Web-based teledermatology consultations. J Telemed 

Telecare 2004 10(1):25-8. 

Pak HS, Harden D, Cruess D, et al. Teledermatology: 

an intraobserver diagnostic correlation study, part I. 

Cutis 2003 May;71(5):399-403. 

Pak HS, Harden D, Cruess D, et al. Teledermatology: 

an intraobserver diagnostic correlation study, Part II. 

Cutis 2003 Jun;71(6):476-80. 

Patricoski C, Kokesh J, Ferguson AS, et al. A 

comparison of in-person examination and video 

otoscope imaging for tympanostomy tube follow-up. 

Telemed J E Health 2003 Winter;9(4):331-44. 

Phillips VL, Vesmarovich S, Hauber R, et al. 

Telehealth: reaching out to newly injured spinal cord 

patients. Public Health Rep 2001 116(Suppl 1):94-

102. 

Piccolo D, Smolle J, Argenziano G, et al. 

Teledermoscopy--results of a multicentre study on 43 

pigmented skin lesions. J Telemed Telecare 2000 

6(3):132-7. 

Piccolo D, Soyer HP, Burgdorf W, et al. Concordance 

between telepathologic diagnosis and conventional 

histopathologic diagnosis: a multiobserver store-andforward study on 20 skin specimens.[see comment]. 

Arch Dermatol 2002 Jan;138(1):53-8. 

Rashid E, Ishtiaq O, Gilani S, et al. Comparison of 

store and forward method of teledermatology with 

face-to-face consultation. J Ayub Med Coll 

Abbottabad 2003 Apr-Jun;15(2):34-6. 

Rayner S, Beaconsfield M, Kennedy C, et al. 

Subspecialty adnexal ophthalmological examination
C-32

using telemedicine. J Telemed Telecare 2001 7(Suppl 

1):29-31. 

Rogers MA, Small D, Buchan DA, et al. Home 

monitoring service improves mean arterial pressure in 

patients with essential hypertension. A randomized, 

controlled trial.[see comment]. Ann Intern Med 2001 

Jun 5;134(11):1024-32. 

Roth A, Kajiloti I, Elkayam I, et al. Telecardiology for 

patients with chronic heart failure: the 'SHL' 

experience in Israel. Int J Cardiol 2004 Oct;97(1):49-

55. 

Ruskin PE, Silver-Aylaian M, Kling MA, et al. 

Treatment outcomes in depression: comparison of 

remote treatment through telepsychiatry to in-person 

treatment. Am J Psychiatry 2004 Aug;161(8):1471-6. 

Russell TG, Jull GA, Wootton R. Can the Internet be 

used as a medium to evaluate knee angle? Manual 

Ther 2003 Nov;8(4):242-6. 

Saari JM, Summanen P, Kivela T, et al. Sensitivity 

and specificity of digital retinal images in grading 

diabetic retinopathy. Acta Ophthalmol Scand 2004 

Apr;82(2):126-30. 

Scalvini S, Zanelli E, Conti C, et al. Assessment of 

prehospital chest pain using telecardiology. J Telemed 

Telecare 2002 8(4):231-6. 

Shapiro M, James WD, Kessler R, et al. Comparison 

of skin biopsy triage decisions in 49 patients with 

pigmented lesions and skin neoplasms: store-andforward teledermatology vs face-to-face dermatology. 

Arch Dermatol 2004 May;140(5):525-8. 

Shiba T, Yamamoto T, Seki U, et al. Screening and 

follow-up of diabetic retinopathy using a new mosaic 

9-field fundus photography system. Diabetes Res Clin 

Pract 2002 Jan;55(1):49-59. 

Shores MM, Ryan-Dykes P, Williams RM, et al. 

Identifying undiagnosed dementia in residential care 

veterans: comparing telemedicine to in-person clinical 

examination. Int J Geriatr Psychiatry 2004 

Feb;19(2):101-8. 

Smith LF, Bainbridge J, Burns J, et al. Evaluation of 

telemedicine for slit lamp examination of the eye 

following cataract surgery. Br J Ophthalmol 2003 

Apr;87(4):502-3. 

Taylor P, Goldsmith P, Murray K, et al. Evaluating a 

telemedicine system to assist in the management of 

dermatology referrals. Br J Dermatol 2001 

Feb;144(2):328-33. 

Taylor P, Kennedy C, Murdoch I, et al. Assessment of 

benefit in tele-ophthalmology using a consensus panel. 

J Telemed Telecare 2003 9(3):140-5. 

Tennant MT, Rudnisky CJ, Hinz BJ, et al. Teleophthalmology via stereoscopic digital imaging: a 

pilot project. Diabetes Technol Ther 2000 2(4):583-7. 

Terkelsen CJ, Norgaard BL, Lassen JF, et al. 

Telemedicine used for remote prehospital diagnosing 

in patients suspected of acute myocardial infarction. J 

Intern Med 2002 Nov;252(5):412-20. 

Ullah R, Gilliland D, Adams D. Otolaryngology 

consultations by real-time telemedicine. Ulster Med J 

2002 May;71(1):26-9. 

Vuolio S, Winblad I, Ohinmaa A, et al. 

Videoconferencing for orthopaedic outpatients: oneyear follow-up. J Telemed Telecare 2003 9(1):8-11. 

Wallace P, Haines A, Harrison R, et al. Joint 

teleconsultations (virtual outreach) versus standard 

outpatient appointments for patients referred by their 

general practitioner for a specialist opinion: a 

randomised trial.[see comment]. Lancet 2002 Jun 

8;359(9322):1961-8. 

Wang S, Lee SB, Pardue C, et al. Remote evaluation 

of acute ischemic stroke: reliability of National 

Institutes of Health Stroke Scale via telestroke.[see 

comment]. Stroke 2003 Oct;34(10):e188-91. 

Welch G, Sokolove M, Mullin C, et al. Use of a 

Modem-Equipped Blood Glucose Meter Augmented 

with Bi-Weekly Educator Telephone Support Lowers 

HbA1c in Type 1 Diabetes. Diabetes 2003 52 (Suppl. 

1):A100-A101. 

Whited JD, Hall RP, Foy ME, et al. Teledermatology's 

impact on time to intervention among referrals to a 

dermatology consult service. Telemed J E Health 2002 

Fall;8(3):313-21. 

Wilbright WA, Birke JA, Patout CA, et al. The use of 

telemedicine in the management of diabetes-related 

foot ulceration: a pilot study. Adv Skin Wound Care 

2004 Jun;17(5 Pt 1):232-8. 

Wildi SM, Kim CY, Glenn TF, et al. Tele-endoscopy: 

a way to provide diagnostic quality for remote 

populations. Gastrointest Endosc 2004 Jan;59(1):38-

43. 

Woods KF, Johnson JA, Kutlar A, et al. Sickle cell 

disease telemedicine network for rural outreach. J 

Telemed Telecare 2000 6(5):285-90. 

Yogesan K, Constable IJ, Barry CJ, et al. 

Telemedicine screening of diabetic retinopathy using a 

hand-held fundus camera. Telemedicine Journal 2000 

6(2):219-23. 

Yoshino A, Shigemura J, Kobayashi Y, et al. 

Telepsychiatry: assessment of televideo psychiatric
C-33

 interview reliability with present- and next-generation 

internet infrastructures. Acta Psychiatr Scand 2001 

Sep;104(3):223-6 
D-1

Appendix D: Listing of Excluded Studies

Aarnio P, Jaatinen P, Hakkari K, et al. A new method 

for surgical consultations with videoconference. 

Annales Chirurgiae et Gynaecologiae 2000 89(4):336-

40. 

Excluded - contains no or inadequate data 

Aarnio P, Rudenberg H, Ellonen M, et al. User 

satisfaction with teleconsultations for surgery. J 

Telemed Telecare 2000 6(4):237-41. 

Excluded - does not meet our definition of 

telemedicine 

Aas IH. A qualitative study of the organizational 

consequences of telemedicine. J Telemed Telecare 

2001 7(1):18-26. 

Excluded - contains no or inadequate data 

Abbott KC, Mann S, DeWitt D, et al. Physician-tophysician consultation via electronic mail: the Walter 

Reed Army Medical Center Ask a Doc system. Mil 

Med 2002 Mar; 167(3):200-4. 

Excluded - does not meet our definition of 

telemedicine 

Abdoh AA, Krousel-Wood MA and Re RN. Accuracy 

of telemedicine in detecting uncontrolled hypertension 

and its impact on patient management. Telemed J E 

Health 2003 Winter; 9(4):315-23. 

Excluded - does not address a key question 

Abrahamian H, Schueller A, Mauler H, et al. Transfer 

of knowledge from the specialist to the generalist by 

videoconferencing: effect on diabetes care. J Telemed 

Telecare 2002 8(6):350-5. 

Excluded - contains no or inadequate data 

Agha Z, Schapira RM and Maker AH. Cost 

effectiveness of telemedicine for the delivery of 

outpatient pulmonary care to a rural population. 

Telemed J E Health 2002 Fall; 8(3):281-91. 

Excluded - does not address a key question 

Albisser AM. Clinical studies with home glucose 

clamping. Ann Endocrinol (Paris) 2001 Feb; 62(1 Pt 

1):11-8. 

Excluded - no comparison group 

Alessi NE. Quantitative documentation of the 

therapeutic efficacy of adolescent telepsychiatry. 

Telemed J E Health 2003 Fall; 9(3):283-9. 

Excluded - contains no or inadequate data 

Amir O and Shabtai E. Public information services in 

the field of communication disorders: comparison 

between teleservice and E-service. Telemed J E Health 

2002 Winter; 8(4):369-75. 

Excluded - does not address a key question 

Andersson G, Lundstrom P and Strom L. Internetbased treatment of headache: does telephone contact 

add anything? Headache 2003 Apr; 43(4):353-61. 

Excluded - does not meet our definition of 

telemedicine 

Andrews D, Gouda MS, Higgins S, et al. A 

comparative study of a new wireless continuous 

cardiorespiratory monitor for the diagnosis and 

management of patients with congestive heart failure 

at home.[erratum appears in J Telemed Telecare. 

2002;8(6):361.]. J Telemed Telecare 2002 8(Suppl 

2):101-3. 

Excluded - contains no or inadequate data 

Anonymous. Summaries for patients. Home 

monitoring service improves blood pressure control in 

patients with high blood pressure. Ann Intern Med 

2001 Jun 5; 134(11):S-9. 

Excluded - does not address a key question 

Anonymous. Sacramento hospital boosts outcomes by 

focusing on high-risk CHF patients. Data Strategies & 

Benchmarks 2001 May; 5(5):68-7, 65. 

Excluded - contains no or inadequate data 

Anonymous. CHF managers make the case for homemonitoring technology. Dis Manag Advis 2002 Oct; 

8(10):156-8, 145. 

Excluded - does not address a key question 

Anonymous. Demo produces stunning results in care 

of complex patients. Clinical Resource Management 

2002 Feb; 3(2):21-5. 

Excluded - contains no or inadequate data 

Anonymous. Study suggests video visits have 

significant cost, quality benefits. Dis Manag Advis 

2002 Mar; 8(3):44-7, 33. 

Excluded - contains no or inadequate data 

Anonymous. Online doctor-patient communication 

tool saves time on phone. Perform Improv Advis 2003 

Mar; 7(3):37-9. 

Excluded - does not address a key question 

Appel PR, Bleiberg J and Noiseux J. Self-regulation 

training for chronic pain: can it be done effectively by 

telemedicine? Telemed J E Health 2002 Winter; 

8(4):361-8. 

Excluded - contains no or inadequate data 

Aris IB, Wagie AA, Mariun NB, et al. An internetbased blood pressure monitoring system for patients. J 

Telemed Telecare 2001 7(1):51-3. 

Excluded - no comparison group 
D-2

Arthur HM, Smith KM, Kodis J, et al. A controlled 

trial of hospital versus home-based exercise in cardiac 

patients. Med Sci Sports Exerc 2002 Oct; 

34(10):1544-50. 

Excluded - does not address a key question 

Aucar J, Granchi T, Liscum K, et al. Is regionalization 

of trauma care using telemedicine feasible and 

desirable? American Journal of Surgery 2000 

180(6):535-9. 

Excluded - does not address a key question 

Axford AT, Askill C and Jones AJ. Virtual 

multidisciplinary teams for cancer care. J Telemed 

Telecare 2002 8(Suppl 2):3-4. 

Excluded - does not meet our definition of 

telemedicine 

Ayyagari A, Bhargava A, Agarwal R, et al. Use of 

telemedicine in evading cholera outbreak in 

Mahakumbh Mela, Prayag, UP, India: an encouraging 

experience. Telemed J E Health 2003 Spring; 9(1):89-

94. 

Excluded - does not address a key question 

Bakke B, Mitchell J, Wonderlich S, et al. 

Administering cognitive-behavioral therapy for 

bulimia nervosa via telemedicine in rural settings. Int J 

Eat Disord 2001 Dec; 30(4):454-7. 

Excluded - no comparison group 

Baldwin L, Clarke M, Hands L, et al. The effect of 

telemedicine on consultation time. J Telemed Telecare 

2003 9(Suppl 1):S71-3. 

Excluded - does not address a key question 

Ballantyne GH, Hourmont K and Wasielewski A. 

Telerobotic laparoscopic repair of incisional ventral 

hernias using intraperitoneal prosthetic mesh. J Soc 

Laparoendosc Surg 2003 Jan-Mar; 7(1):7-14. 

Excluded - does not address a key question 

Banerjee S, Steenkeste F, Couturier P, et al. 

Telesurveillance of elderly patients by use of passive 

infra-red sensors in a 'smart' room. J Telemed Telecare 

2003 9(1):23-9. 

Excluded - does not meet our definition of 

telemedicine 

Barry CJ, Henderson C, Kanagasingam Y, et al. 

Working toward a portable tele-ophthalmic system for 

use in maximum-security prisons: a pilot study. 

Telemed J E Health 2001 Fall; 7(3):261-5. 

Excluded - wrong population 

Baruffaldi F, Gualdrini G and Toni A. Comparison of 

asynchronous and realtime teleconsulting for 

orthopaedic second opinions. J Telemed Telecare 

2002 8(5):297-301. 

Excluded - contains no or inadequate data 

Beach M, Goodall I and Miller P. Evaluating 

telemedicine for minor injuries units. J Telemed 

Telecare 2000 6(1) 

Excluded - no comparison group 

Bellazzi R, Larizza C, Montani S, et al. A 

telemedicine support for diabetes management: the TIDDM project. Comput Methods Programs Biomed 

2002 Aug; 69(2):147-61. 

Excluded - does not address a key question 

Bellon E, Aerts W, Vanautgaerden M, et al. Webaccess to a central medical record to improve 

cooperation between hospital and referring physicians. 

Studies in Health Technology & Informatics 2002 

93:145-53. 

Excluded - does not address a key question 

Belmont JM and Mattioli LF. Accuracy of analog 

telephonic stethoscopy for pediatric telecardiology. 

Pediatrics 2003 Oct; 112(4):780-6. 

Excluded - wrong population 

Benger J, Lock A, Cook J, et al. The effect of 

resolution, compression, colour depth and display 

modality on the accuracy of accident and emergency 

telemedicine. J Telemed Telecare 2001 7(Suppl 1):6-

7. 

Excluded - does not address a key question 

Bennett SJ, Hays LM, Embree JL, et al. Heart 

Messages: a tailored message intervention for 

improving heart failure outcomes. Journal of 

Cardiovascular Nursing 2000 14(4):94-105. 

Excluded - does not meet our definition of 

telemedicine 

Berendt M, Schaefer B, Heglund MJ, et al. Telehealth 

for effective disease state management. Home Care 

Provid 2001 Apr; 6(2):67-72. 

Excluded - does not address a key question 

Berg BW, Vincent DS and Hudson DA. Remote 

critical care consultation: telehealth projection of 

clinical specialty expertise. J Telemed Telecare 2003 

9(Suppl 2):S9-11. 

Excluded - no comparison group 

Bielli E, Carminati F, La Capra S, et al. A Wireless 

Health Outcomes Monitoring System (WHOMS): 

development and field testing with cancer patients 

using mobile phones. BMC Med Inf Decis Mak 2004 

Jun 15; 4(1):7. 

Excluded - does not meet our definition of 

telemedicine 

Billingsley KG, Schwartz DL, Lentz S, et al. The 

development of a telemedical cancer center within the 

Veterans Affairs Health Care System: a report of 

preliminary clinical results. Telemed J E Health 2002 

Spring; 8(1):123-30. 

Excluded - contains no or inadequate data 
D-3

Bishai DM, Ferris DG and Litaker MS. What is the 

least costly strategy to evaluate cervical abnormalities 

in rural women? Comparing telemedicine, local 

practitioners, and expert physicians. Med Decis 

Making 2003 Nov-Dec; 23(6):463-70. 

Excluded - does not address a key question 

Bishop JE, O'Reilly RL, Maddox K, et al. Client 

satisfaction in a feasibility study comparing face-toface interviews with telepsychiatry. J Telemed 

Telecare 2002 8(4):217-21. 

Excluded - does not address a key question 

Blomdahl S, Calissendorff B and Jacobsson U. 

Patient-focused urban tele-ophthalmology services. J 

Telemed Telecare 2002 8(Suppl 2):43-4. 

Excluded - contains no or inadequate data 

Blomdahl S, Maren N and Lof R. Tele-ophthalmology 

for the treatment in primary care of disorders in the 

anterior part of the eye. J Telemed Telecare 2001 

7(Suppl 1):25-6. 

Excluded - contains no or inadequate data 

Bose U, McLaren P, Riley A, et al. The use of 

telepsychiatry in the brief counselling of nonpsychotic patients from an inner-London general 

practice. J Telemed Telecare 2001 7(Suppl 1):8-10. 

Excluded - contains no or inadequate data 

Boukhors Y, Rabasa-Lhoret R, Langelier H, et al. The 

use of information technology for the management of 

intensive insulin therapy in type 1 diabetes mellitus. 

Diabetes Metab 2003 Dec; 29(6):619-27. 

Excluded - does not meet our definition of 

telemedicine 

Boulanger B, Kearney P, Ochoa J, et al. Telemedicine: 

a solution to the followup of rural trauma patients? J 

Am Coll Surg 2001 Apr; 192(4):447-52. 

Excluded - does not address a key question 

Bove P, Stoianovici D, Micali S, et al. Is telesurgery a 

new reality? Our experience with laparoscopic and 

percutaneous procedures. J Endourol 2003 Apr; 

17(3):137-42. 

Excluded - does not address a key question 

Bowater M. The experience of a rural general 

practitioner using videoconferencing for telemedicine. 

J Telemed Telecare 2001 7(Suppl 2):24-5. 

Excluded - contains no or inadequate data 

Bracale M, Cesarelli M and Bifulco P. Telemedicine 

services for two islands in the Bay of Naples. J 

Telemed Telecare 2002 8(1):5-10. 

Excluded - does not address a key question 

Braun RP, Meier M, Pelloni F, et al. 

Teledermatoscopy in Switzerland: a preliminary 

evaluation. Journal of the American Academy of 

Dermatology 2000 42(5 Pt 1):770-5. 

Excluded - included in previous report 

Brebner EM and Brebner JA. Implementation and 

evaluation of telemedicine for remote health-care--the 

European Northern Periphery Programme Project. J 

Telemed Telecare 2001 7(Suppl 1):68-9. 

Excluded - does not address a key question 

Brebner EM, Brebner JA, Ruddick-Bracken H, et al. 

Evaluation of a pilot telemedicine network for 

accident and emergency work. J Telemed Telecare 

2002 8(Suppl 2):5-6. 

Excluded - contains no or inadequate data 

Brebner EM, Brebner JA, Ruddick-Bracken H, et al. 

Evaluation of an accident and emergency 

teleconsultation service for north-east Scotland. J 

Telemed Telecare 2004 10(1):16-20. 

Excluded - contains no or inadequate data 

Brebner JA, Brebner EM, Ruddick-Bracken H, et al. 

The development of a pilot telemedicine network in 

Scotland: lessons learned. J Telemed Telecare 2001 

7(Suppl 2):83-4. 

Excluded - contains no or inadequate data 

Bremner F, Kennedy C, Rees A, et al. Usefulness of 

teleconsultations in neuro-ophthalmology. J Telemed 

Telecare 2002 8(5):305-6. 

Excluded - contains no or inadequate data 

Brennan DM, Georgeadis AC, Baron CR, et al. The 

effect of videoconference-based telerehabilitation on 

story retelling performance by brain-injured subjects 

and its implications for remote speech-language 

therapy. Telemed J E Health 2004 Summer; 

10(2):147-54. 

Excluded - contains no or inadequate data 

Brennan PF, Moore SM, Bjornsdottir G, et al. 

HeartCare: an Internet-based information and support 

system for patient home recovery after coronary artery 

bypass graft (CABG) surgery.[see comment]. J Adv 

Nurs 2001 Sep; 35(5):699-708. 

Excluded - contains no or inadequate data 

Brenner B. Is the provision of laboratory results via 

the Internet acceptable to patients? A survey of private 

patients in a large, specialist gynaecology practice. N 

Z Med J 2003 Dec 12; 116(1187):U711. 

Excluded - does not address a key question 

Brian J and Jamieson S. Post-surgical cardiac patients 

receive new level of care. Caring 2002 Mar; 21(3):28-

9. 

Excluded - does not address a key question 

Broderick TJ, Harnett BM, Doarn CR, et al. Real-time 

Internet connections: implications for surgical 
D-4

decision making in laparoscopy. Ann Surg 2001 Aug; 

234(2):165-71. 

Excluded - does not address a key question 

Brodey BB, Claypoole KH, Motto J, et al. Satisfaction 

of forensic psychiatric patients with remote 

telepsychiatric evaluation. Psychiatr Serv 1305 

51(10):1305-7. 

Excluded - wrong population 

Brown-Connolly NE. Patient satisfaction with 

telemedical access to specialty services in rural 

California. J Telemed Telecare 2002 8(Suppl 2):7-10. 

Excluded - does not address a key question 

Brownrigg P, Lowry JC, Edmondson MJ, et al. 

Telemedicine in oral surgery and maxillofacial 

trauma: a descriptive account. Telemed J E Health 

2004 Spring; 10(1):27-31. 

Excluded - contains no or inadequate data 

Burgess LP, Syms MJ, Holtel MR, et al. 

Telemedicine: teleproctored endoscopic sinus surgery. 

Laryngoscope 2002 Feb; 112(2):216-9. 

Excluded - contains no or inadequate data 

Bursell SE, Cavallerano JD, Cavallerano AA, et al. 

Stereo nonmydriatic digital-video color retinal 

imaging compared with Early Treatment Diabetic 

Retinopathy Study seven standard field 35-mm stereo 

color photos for determining level of diabetic 

retinopathy. Ophthalmology 2001 Mar; 108(3):572-

85. 

Excluded - does not meet our definition of 

telemedicine 

Buurke JH, Kleissen RF, Nene A, et al. A feasibility 

study of remote consultation to determine suitability 

for surgery in stroke rehabilitation. J Telemed 

Telecare 2004 10(2):108-12. 

Excluded - contains no or inadequate data 

Bynum A, Hopkins D, Thomas A, et al. The effect of 

telepharmacy counseling on metered-dose inhaler 

technique among adolescents with asthma in rural 

Arkansas. Telemed J E Health 2001 Fall; 7(3):207-17. 

Excluded - wrong population 

Bynum AB, Cranford CO, Irwin CA, et al. Participant 

satisfaction with a school telehealth education 

program using interactive compressed video delivery 

methods in rural Arkansas. J Sch Health 2002 Aug; 

72(6):235-42. 

Excluded - wrong population 

Bynum AB, Irwin CA, Cranford CO, et al. The impact 

of telemedicine on patients' cost savings: some 

preliminary findings. Telemed J E Health 2003 

Winter; 9(4):361-7. 

Excluded - does not address a key question 

Byrne JP and Mughal MM. Telementoring as an 

adjunct to training and competence-based assessment 

in laparoscopic cholecystectomy. Surgical Endoscopy 

1159 14(12):1159-61. 

Excluded - does not address a key question 

Cabrera MF, Arredondo MT and Quiroga J. 

Integration of telemedicine into emergency medical 

services. J Telemed Telecare 2002 8(Suppl 2):12-4. 

Excluded - contains no or inadequate data 

Cadiere GB, Himpens J, Vertruyen M, et al. 

Evaluation of telesurgical (robotic) NISSEN 

fundoplication. Surgical Endoscopy 2001 Sep; 

15(9):918-23. 

Excluded - does not address a key question 

Car J and Sheikh A. Email consultations in health 

care: 1--scope and effectiveness. Bmj 2004 Aug 21; 

329(7463):435-8. 

Excluded - does not address a key question 

Car J and Sheikh A. Email consultations in health 

care: 2--acceptability and safe application. Bmj 2004 

Aug 21; 329(7463):439-42. 

Excluded - does not address a key question 

Cargill A and Watson AR. Telecare support for 

patients undergoing chronic peritoneal dialysis. Perit 

Dial Int 2003 Jan-Feb; 23(1):91-4. 

Excluded - does not address a key question 

Cathala N, Brillat F, Mombet A, et al. Patient 

followup after radical prostatectomy by Internet 

medical file. J Urol 2003 Dec; 170(6 Pt 1):2284-7. 

Excluded - does not address a key question 

Cavallerano AA, Cavallerano JD, Katalinic P, et al. 

Use of Joslin Vision Network digital-video 

nonmydriatic retinal imaging to assess diabetic 

retinopathy in a clinical program. Retina 2003 Apr; 

23(2):215-23. 

Excluded - no comparison group 

Cavan DA, Everett J, Plougmann S, et al. Use of the 

Internet to optimize self-management of type 1 

diabetes: preliminary experience with DiasNet. J 

Telemed Telecare 2003 9(Suppl 1):S50-2. 

Excluded - contains no or inadequate data 

Cavina E, Goletti O, Lippolis PV, et al. 

Telesonography: technical problems, solutions and 

results in the routine utilization from remote areas. 

Studies in Health Technology & Informatics 2001 

81:88-9. 

Excluded - does not address a key question 

Cawthorpe D. An evaluation of a computer-based 

psychiatric assessment: evidence for expanded use. 

Cyberpsychol Behav 2001 Aug; 4(4):503-10. 

Excluded - contains no or inadequate data 
D-5

Cervi PL and Everitt AS. Automatic voice mail for 

delivering computer-generated anticoagulant dose 

advice to patients. J Telemed Telecare 2002 8(5):259-

63. 

Excluded - does not address a key question 

Chae YM, Heon Lee J, Hee Ho S, et al. Patient 

satisfaction with telemedicine in home health services 

for the elderly. Int J Med Inf 2001 May; 61(2-3):167-

73. 

Excluded - does not address a key question 

Chae YM, Park HJ, Cho JG, et al. The reliability and 

acceptability of telemedicine for patients with 

schizophrenia in Korea. J Telemed Telecare 2000 

6(2):83-90. 

Excluded - does not address a key question 

Chambers M and Connor S. Technology as an aid to 

coping with caring: a usability evaluation of a 

telematics intervention. Medinfo 2001 10(Pt 2):1130-

4. 

Excluded - does not meet our definition of 

telemedicine 

Chambers M and Connor SL. User-friendly 

technology to help family carers cope. J Adv Nurs 

2002 Dec; 40(5):568-77. 

Excluded - does not meet our definition of 

telemedicine 

Chambers MG, Connor SL, McGonigle M, et al. 

Multimedia software to help caregivers cope. J Am 

Med Inform Assoc 2003 Sep-Oct; 10(5):504-11. 

Excluded - does not meet our definition of 

telemedicine 

Chan DS, Callahan CW, Sheets SJ, et al. An Internetbased store-and-forward video home telehealth system 

for improving asthma outcomes in children. Am J 

Health Syst Pharm 2003 Oct 1; 60(19):1976-81. 

Excluded - wrong population 

Chan WM, Woo J, Hui E, et al. The role of telenursing 

in the provision of geriatric outreach services to 

residential homes in Hong Kong. J Telemed Telecare 

2001 7(1):38-46. 

Excluded - contains no or inadequate data 

Chao LW, Cestari TF, Bakos L, et al. Evaluation of an 

Internet-based teledermatology system. J Telemed 

Telecare 2003 9(Suppl 1):S9-12. 

Excluded - contains no or inadequate data 

Chao LW, Enokihara MY, Silveira PS, et al. 

Telemedicine model for training non-medical persons 

in the early recognition of melanoma. J Telemed 

Telecare 2003 9(Suppl 1):S4-7. 

Excluded - contains no or inadequate data 

Chase HP, Pearson JA, Wightman C, et al. Modem 

transmission of glucose values reduces the costs and 

need for clinic visits.[see comment]. Diabetes Care 

2003 May; 26(5):1475-9. 

Excluded - wrong population 

Chen K, Lim A and Shumack S. Teledermatology: 

influence of zoning and education on a clinician's 

ability to observe peripheral lesions. Australas J 

Dermatol 2002 Aug; 43(3):171-4. 

Excluded - contains no or inadequate data 

Chen RS and Chen SK. Teledentistry using 

videoconferencing and a DICOM image management 

system. J Telemed Telecare 2002 8(4):244-6. 

Excluded - contains no or inadequate data 

Cherry JC, Dryden K, Kobb R, et al. Opening a 

window of opportunity through technology and 

coordination: a multisite case study. Telemed J E 

Health 2003 Fall; 9(3):265-71. 

Excluded - contains no or inadequate data 

Cherry JC, Moffatt TP, Rodriguez C, et al. Diabetes 

disease management program for an indigent 

population empowered by telemedicine technology. 

Diabetes Technol Ther 2002 4(6):783-91. 

Excluded - does not address a key question 

Chetney R. The Cardiac Connection program: home 

care that doesn't miss a beat. Home Healthc Nurse 

2003 Oct; 21(10):680-6. 

Excluded - does not address a key question 

Cheung JC, Dick PT, Kraft SP, et al. Strabismus 

examination by telemedicine. Ophthalmology 1999 

107(11):1999-2005. 

Excluded - wrong population 

Choremis J and Chow DR. Use of telemedicine in 

screening for diabetic retinopathy.[see comment]. Can 

J Ophthalmol 2003 Dec; 38(7):575-9. 

Excluded - no comparison group 

Chua R, Craig J, Wootton R, et al. Cost implications 

of outpatient teleneurology. J Telemed Telecare 2001 

7(Suppl 1):62-4. 

Excluded - does not address a key question 

Cipolat C, Bader U, Rufli T, et al. Teledermatology in 

Switzerland. Aktuelle Probl Dermatol 2003 32:257-

60. 

Excluded - contains no or inadequate data 

Clement PF, Brooks FR, Dean B, et al. A 

neuropsychology telemedicine clinic. Mil Med 2001 

May; 166(5):382-4. 

Excluded - contains no or inadequate data 

Clifton GD, Byer H, Heaton K, et al. Provision of 

pharmacy services to underserved populations via 

remote dispensing and two-way videoconferencing. 

Am J Health Syst Pharm 2003 Dec 15; 60(24):2577-

82. 
D-6

Excluded - does not address a key question 

Collins K, Bowns I and Walters S. General 

practitioners' perceptions of asynchronous 

telemedicine in a randomized controlled trial of 

teledermatology. J Telemed Telecare 2004 10(2):94-8. 

Excluded - contains no or inadequate data 

Collins K, Walters S and Bowns I. Patient satisfaction 

with teledermatology: quantitative and qualitative 

results from a randomized controlled trial. J Telemed 

Telecare 2004 10(1):29-33. 

Excluded - does not address a key question 

Collins PW, Bolton-Maggs P, Stephenson D, et al. 

Pilot study of an Internet-based electronic patient 

treatment record and communication system for 

haemophilia, Advoy.com. Haemophilia 2003 May; 

9(3):285-91. 

Excluded - does not address a key question 

Cone SW, Gehr L, Hummel R, et al. Case report of 

remote anesthetic monitoring using telemedicine. 

Anesth Analg 2004 Feb; 98(2):386-8, table of 

contents. 

Excluded - contains no or inadequate data 

Constable IJ, Yogesan K, Eikelboom R, et al. Fred 

Hollows lecture: digital screening for eye disease. 

Clinical & Experimental Ophthalmology 2000 

28(3):129-32. 

Excluded - does not address a key question 

Cook DJ, Doolittle GC and Whitten PS. Administrator 

and provider perceptions of the factors relating to 

programme effectiveness in implementing 

telemedicine to provide end-of-life care. J Telemed 

Telecare 2001 7(Suppl 2):17-9. 

Excluded - does not address a key question 

Cook HL, Heacock GL, Stanford MR, et al. Detection 

of retinal lesions after telemedicine transmission of 

digital images. Eye 2000 14(Pt 4):563-71. 

Excluded - does not meet our definition of 

telemedicine 

Cook J, Edwards J, Mullings C, et al. Dentists' 

opinions of an online orthodontic advice service. J 

Telemed Telecare 2001 7(6):334-7. 

Excluded - does not address a key question 

Cook J, Mullings C, Vowles R, et al. Online 

orthodontic advice: a protocol for a pilot teledentistry 

system. J Telemed Telecare 2001 7(6):324-33. 

Excluded - contains no or inadequate data 

Corcoran H, Hui E and Woo J. The acceptability of 

telemedicine for podiatric intervention in a residential 

home for the elderly. J Telemed Telecare 2003 

9(3):146-9. 

Excluded - contains no or inadequate data 

Cornish PA, Church E, Callanan T, et al. Rural 

interdisciplinary mental health team building via 

satellite: a demonstration project. Telemed J E Health 

2003 Spring; 9(1):63-71. 

Excluded - does not address a key question 

Corr P, Couper I, Beningfield SJ, et al. A simple 

telemedicine system using a digital camera. J Telemed 

Telecare 2000 6(4):233-6. 

Excluded - does not meet our definition of 

telemedicine 

Cowain T. Cognitive-behavioural therapy via 

videoconferencing to a rural area. Aust N Z J 

Psychiatry 2001 Feb; 35(1):62-4. 

Excluded - no comparison group 

Coyle N, Khojainova N, Francavilla JM, et al. Audiovisual communication and its use in palliative care. J 

Pain Symptom Manage 2002 Feb; 23(2):171-5. 

Excluded - contains no or inadequate data 

Craig J, Chua R, Russell C, et al. A cohort study of 

early neurological consultation by telemedicine on the 

care of neurological inpatients. J Neurol Neurosurg 

Psychiatry 2004 Jul; 75(7):1031-5. 

Excluded - contains no or inadequate data 

Cummings DM, Morrissey S, Barondes MJ, et al. 

Screening for diabetic retinopathy in rural areas: the 

potential of telemedicine. J Rural Health 2001 Winter; 

17(1):25-31. 

Excluded - no comparison group 

Dadd M, Doyle B, Wilson L, et al. Lessons learned 

from the Hospital Without Walls project. J Telemed 

Telecare 2002 8(Suppl 3):S3:11-4. 

Excluded - does not address a key question 

Dale J, Connor S and Tolley K. An evaluation of the 

west Surrey telemedicine monitoring project. J 

Telemed Telecare 2003 9(Suppl 1):S39-41. 

Excluded - contains no or inadequate data 

d'Annunzio G, Bellazzi R, Larizza C, et al. 

Telemedicine in the management of young patients 

with type 1 diabetes mellitus: a follow-up study. Acta 

Biomed Ateneo Parmense 2003 74(Suppl 1):49-55. 

Excluded - contains no or inadequate data 

Dansky KH and Bowles KH. Lessons learned from a 

telehomecare project. Caring 2002 Apr; 21(4):18-22. 

Excluded - contains no or inadequate data 

Dansky KH, Palmer L, Shea D, et al. Cost analysis of 

telehomecare. Telemed J E Health 2001 Fall; 

7(3):225-32. 

Excluded - does not address a key question 

Dansky KH, Yant B, Jenkins D, et al. Qualitative 

analysis of telehomecare nursing activities. Journal of 

Nursing Administration 2003 Jul-Aug; 33(7-8):372-5. 
D-7

Excluded - contains no or inadequate data 

Davis P. The application of telehealth to 

rheumatology. Clin Rheumatol 2003 Sep; 22(3):168-

72. 

Excluded - contains no or inadequate data 

Davis P, Howard R and Brockway P. Telehealth 

consultations in rheumatology: cost-effectiveness and 

user satisfaction. J Telemed Telecare 2001 7(Suppl 

1):10-1. 

Excluded - does not address a key question 

Davis P, Howard R and Brockway P. An evaluation of 

telehealth in the provision of rheumatologic consults 

to a remote area.[see comment]. J Rheumatol 2001 

Aug; 28(8):1910-3. 

Excluded - does not address a key question 

Davis RM, Fowler S, Bellis K, et al. Telemedicine 

improves eye examination rates in individuals with 

diabetes: a model for eye-care delivery in underserved 

communities. Diabetes Care 2003 Aug; 26(8):2476. 

Excluded - does not address a key question 

De Las Cuevas C, Artiles J, De La Fuente J, et al. 

Telepsychiatry in the Canary Islands: user acceptance 

and satisfaction. J Telemed Telecare 2003 9(4):221-4. 

Excluded - does not address a key question 

de Lusignan S, Althans A, Wells S, et al. A pilot study 

of radiotelemetry for continuous cardiopulmonary 

monitoring of patients at home. J Telemed Telecare 

2000 6(1) 

Excluded - contains no or inadequate data 

Deb N, Thuret G, Estour B, et al. Screening for 

diabetic retinopathy in France. Diabetes Metab 2004 

Apr; 30(2):140-5. 

Excluded - contains no or inadequate data 

Debray M, Couturier P, Greuillet F, et al. A 

preliminary study of the feasibility of wound telecare 

for the elderly. J Telemed Telecare 2001 7(6):353-8. 

Excluded - contains no or inadequate data 

Deitsch SE, Frueh BC and Santos AB. Telepsychiatry 

for post-traumatic stress disorder. J Telemed Telecare 

2000 6(3):184-6. 

Excluded - contains no or inadequate data 

DeLeo G, Krishna S, Balas EA, et al. WEB-WAP 

based telecare. Proc AMIA Symp 2002:200-4. 

Excluded - contains no or inadequate data 

Delgado DH, Costigan J, Wu R, et al. An interactive 

Internet site for the management of patients with 

congestive heart failure. Can J Cardiol 2003 Nov; 

19(12):1381-5. 

Excluded - contains no or inadequate data 

DeMaio J, Schwartz L, Cooley P, et al. The 

application of telemedicine technology to a directly 

observed therapy program for tuberculosis: a pilot 

project. Clin Infect Dis 2001 Dec 15; 33(12):2082-4. 

Excluded - contains no or inadequate data 

Demartines N. Telemedicine applications in surgery. 

Aktuelle Probl Dermatol 2003 32:94-101. 

Excluded - does not address a key question 

Demartines N, Mutter D, Marescaux J, et al. 

Preliminary assessment of the value and effect of 

expert consultation in telemedicine. J Am Coll Surg 

2000 190(4):466-70. 

Excluded - does not address a key question 

Demartines N, Mutter D, Vix M, et al. Assessment of 

telemedicine in surgical education and patient care. 

Ann Surg 2000 231(2):282-91. 

Excluded - contains no or inadequate data 

Demartines N, Otto U, Mutter D, et al. An evaluation 

of telemedicine in surgery: telediagnosis compared 

with direct diagnosis. Archives of Surgery 2000 

135(7):849-53. 

Excluded - does not address a key question 

Demichelis F, Barbareschi M, Boi S, et al. Robotic 

telepathology for intraoperative remote diagnosis 

using a still-imaging-based system. American Journal 

of Clinical Pathology 2001 Nov; 116(5):744-52. 

Excluded - does not address a key question 

Demiris G, Speedie S, Finkelstein S, et al. 

Communication patterns and technical quality of 

virtual visits in home care. J Telemed Telecare 2003 

9(4):210-5. 

Excluded - does not address a key question 

DeMolles DA, Sparrow D, Gottlieb DJ, et al. A pilot 

trial of a telecommunications system in sleep apnea 

management. Med Care 2004 Aug; 42(8):764-9. 

Excluded - does not meet our definition of 

telemedicine 

Denton IC. Will patients use electronic personal health 

records? Responses from a real-life experience. J 

Healthc Inf Manag 2001 Fall; 15(3):251-9. 

Excluded - does not address a key question 

Deodhar J. Telemedicine by email--experience in 

neonatal care at a primary care facility in rural India. J 

Telemed Telecare 2002 8(Suppl 2):20-1. 

Excluded - does not address a key question 

Diamond BJ, Shreve GM, Bonilla JM, et al. 

Telerehabilitation, cognition and user-accessibility. 

NeuroRehabilitation 2003 18(2):171-7. 

Excluded - does not address a key question 

DiCianni N and Kobza L. A chance to heal. Home 

health agencies can improve patient care and increase 
D-8

profits with telehealth wound consulting. Health 

Manag Technol 2002 Apr; 23(4):22-4. 

Excluded - does not address a key question 

Dimmick SL, Burgiss SG, Robbins S, et al. Outcomes 

of an integrated telehealth network demonstration 

project. Telemed J E Health 2003 Spring; 9(1):13-23. 

Excluded - contains no or inadequate data 

Dimmick SL, Mustaleski C, Burgiss SG, et al. A case 

study of benefits & potential savings in rural home 

telemedicine. Home Healthc Nurse 2000 18(2):124-

35. 

Excluded - does not address a key question 

Doarn CR, Fitzgerald S, Rodas E, et al. Telemedicine 

to integrate intermittent surgical services into primary 

care. Telemed J E Health 2002 Spring; 8(1):131-7. 

Excluded - contains no or inadequate data 

Docherty EM and Ferguson J. Telemedical 

management of an odontoid peg fracture in the 

Shetland Isles. J Telemed Telecare 2000 6(6):350-1. 

Excluded - contains no or inadequate data 

Dreyer NC, Dreyer KA, Shaw DK, et al. Efficacy of 

telemedicine in occupational therapy: a pilot study. J 

Allied Health 2001 Spring; 30(1):39-42. 

Excluded - contains no or inadequate data 

D'Souza R. Telemedicine for intensive support of 

psychiatric inpatients admitted to local hospitals. J 

Telemed Telecare 2000 6(1) 

Excluded - contains no or inadequate data 

Dulou R, Poichotte A, Goasguen O, et al. 

Telemedicine in the management of a cervical 

dislocation by a mobile neurosurgeon. J Telemed 

Telecare 2002 8(4):241-3. 

Excluded - contains no or inadequate data 

Dunn BE, Choi H, Almagro UA, et al. Combined 

robotic and nonrobotic telepathology as an integral 

service component of a geographically dispersed 

laboratory network. Hum Pathol 2001 Dec; 

32(12):1300-3. 

Excluded - does not address a key question 

Dunne MG and Dunne SB. Improved teleradiology 

reporting using fax software. AJR Am J Roentgenol 

2004 Apr; 182(4):871-4. 

Excluded - does not address a key question 

Durtschi A. Three patients' tele-home care 

experiences. Home Healthc Nurse 2001 Jan; 19(1):9-

11. 

Excluded - contains no or inadequate data 

Egol KA, Helfet DL and Koval KJ. Efficacy of 

telemedicine in the initial management of orthopedic 

trauma. Am J Orthop 2003 Jul; 32(7):356-60. 

Excluded - contains no or inadequate data 

Eich HT, Muller RP, Schneeweiss A, et al. Initiation 

of a teleradiotherapeutic network for patients in 

German lymphoma studies. Int J Radiat Oncol Biol 

Phys 2004 Mar 1; 58(3):805-8. 

Excluded - does not address a key question 

Eisdorfer C, Czaja SJ, Loewenstein DA, et al. The 

effect of a family therapy and technology-based 

intervention on caregiver depression. Gerontologist 

2003 Aug; 43(4):521-31. 

Excluded - wrong population 

Ellis DG and Mayrose J. The success of emergency 

telemedicine at the State University of New York at 

Buffalo. Telemed J E Health 2003 Spring; 9(1):73-9. 

Excluded - does not address a key question 

Ellis DG, Mayrose J, Jehle DV, et al. A telemedicine 

model for emergency care in a short-term correctional 

facility. Telemed J E Health 2001 Summer; 7(2):87-

92. 

Excluded - wrong population 

Erlanger D, Kaushik T, Cantu R, et al. Symptombased assessment of the severity of a concussion. J 

Neurosurg 2003 Mar; 98(3):477-84. 

Excluded - does not address a key question 

Fabrizio MD, Lee BR, Chan DY, et al. Effect of time 

delay on surgical performance during telesurgical 

manipulation. J Endourol 2000 14(2):133-8. 

Excluded - does not address a key question 

Farup PG and Skar V. Collaboration by use of the 

Internet yields data of high quality and detects nonuniform management of patients with Helicobacter 

pylori infection.[see comment]. Scand J Gastroenterol 

2002 Dec; 37(12):1466-70. 

Excluded - no comparison group 

Farzanfar R, Finkelstein J and Friedman RH. Testing 

the usability of two automated home-based patientmanagement systems. J Med Syst 2004 Apr; 

28(2):143-53. 

Excluded - does not address a key question 

Faulkner K. Successes and failures in 

videoconferencing: a community health education 

programme. J Telemed Telecare 2001 7(Suppl 2):65-

7. 

Excluded - does not address a key question 

Ferguson J, Rowlands A, Palombo A, et al. Minor 

injuries telemedicine. J Telemed Telecare 2003 

9(Suppl 1):S14-6. 

Excluded - does not address a key question 

Ferris DG, Litaker MS, Gilman PA, et al. Patient 

acceptance and the psychological effects of women 

experiencing telecolposcopy and colposcopy. J Am 

Board Fam Pract 2003 Sep-Oct; 16(5):405-11. 
D-9

Excluded - does not address a key question 

Finch T, May C, Mair F, et al. Integrating service 

development with evaluation in telehealthcare: an 

ethnographic study. Bmj 2003 Nov 22; 

327(7425):1205-9. 

Excluded - does not address a key question 

Finkelstein J, Cabrera MR and Hripcsak G. Internetbased home asthma telemonitoring: can patients 

handle the technology? Chest 2000 117(1):148-55. 

Excluded - included in previous report 

Finkelstein SM, Speedie SM, Demiris G, et al. 

Telehomecare: quality, perception, satisfaction. 

Telemed J E Health 2004 Summer; 10(2):122-8. 

Excluded - contains no or inadequate data 

Fortin JP, Gagnon MP, Cloutier A, et al. Evaluation of 

a telemedicine demonstration project in the Magdalene 

Islands. J Telemed Telecare 2003 9(2):89-94. 

Excluded - contains no or inadequate data 

Fries BE and James M. Identifying "appropriate" 

applicants for home and community based services: 

the MI Choice screening system. Cent Home Care 

Policy Res Policy Briefs 2003 Spring; (13):1-6. 

Excluded - does not address a key question 

Fries BE, Shugarman LR, Morris JN, et al. A 

screening system for Michigan's home- and 

community-based long-term care programs. 

Gerontologist 2002 Aug; 42(4):462-74. 

Excluded - does not address a key question 

Frosch DL, Kaplan RM and Felitti VJ. A randomized 

controlled trial comparing internet and video to 

facilitate patient education for men considering the 

prostate specific antigen test.[see comment]. J Gen 

Intern Med 2003 Oct; 18(10):781-7. 

Excluded - does not address a key question 

Fujiwara T, Nishimura T, Ohkuko T, et al. Rationale 

and design of HOMED-BP Study: hypertension 

objective treatment based on measurement by 

electrical devices of blood pressure study. Blood Press 

Monit 2002 Feb; 7(1):77-82. 

Excluded - contains no or inadequate data 

Galvan FH, Bing EG and Bluthenthal RN. Accessing 

HIV testing and care. Journal of Acquired Immune 

Deficiency Syndromes: JAIDS 2000 25(2):15. 

Excluded - contains no or inadequate data 

Gilbertson L, Langhorne P, Walker A, et al. 

Domiciliary occupational therapy for patients with 

stroke discharged from hospital: randomised 

controlled trial. Bmj 2000 320(7235):603-6. 

Excluded - does not address a key question 

Givens GD, Blanarovich A, Murphy T, et al. Internetbased tele-audiometry system for the assessment of 

hearing: a pilot study. Telemed J E Health 2003 

Winter; 9(4):375-8. 

Excluded - does not address a key question 

Goldfield GS and Boachie A. Delivery of family 

therapy in the treatment of anorexia nervosa using 

telehealth. Telemed J E Health 2003 Spring; 9(1):111-

4. 

Excluded - contains no or inadequate data 

Gomez EJ, Caceres C, Lopez D, et al. A web-based 

self-monitoring system for people living with 

HIV/AIDS. Comput Methods Programs Biomed 2002 

Jul; 69(1):75-86. 

Excluded - contains no or inadequate data 

Gomez EJ, Hernando ME, Garcia A, et al. 

Telemedicine as a tool for intensive management of 

diabetes: the DIABTel experience. Comput Methods 

Programs Biomed 2002 Aug; 69(2):163-77. 

Excluded - no comparison group 

Gonzalez F, Iglesias R, Suarez A, et al. 

Teleophthalmology link between a primary health care 

centre and a reference hospital. Med Inform Internet 

Med 2001 Oct-Dec; 26(4):251-63. 

Excluded - no comparison group 

Graham LE, McGimpsey S, Wright S, et al. Could a 

low-cost audio-visual link be useful in rheumatology? 

J Telemed Telecare 2000 6(1) 

Excluded - included in previous report 

Granlund H. Aspects of quality: face-to-face versus 

teleconsulting. Aktuelle Probl Dermatol 2003 32:158-

66. 

Excluded - does not address a key question 

Granlund H, Thoden CJ, Carlson C, et al. Realtime 

teleconsultations versus face-to-face consultations in 

dermatology: immediate and six-month outcome. J 

Telemed Telecare 2003 9(4):204-9. 

Excluded - does not address a key question 

Gray J, Brain K, Iredale R, et al. A pilot study of 

telegenetics. J Telemed Telecare 2000 6(4):245-7. 

Excluded - does not address a key question 

Gray JE, Safran C, Davis RB, et al. Baby CareLink: 

using the internet and telemedicine to improve care for 

high-risk infants. Pediatrics 1318 106(6):1318-24. 

Excluded - wrong population 

Greist JH, Marks IM, Baer L, et al. Behavior therapy 

for obsessive-compulsive disorder guided by a 

computer or by a clinician compared with relaxation 

as a control. J Clin Psychiatry 2002 Feb; 63(2):138-45. 

Excluded - does not meet our definition of 

telemedicine 

Guilfoyle C, Wootton R, Hassall S, et al. 

Videoconferencing in facilities providing care for 
D-10

elderly people. J Telemed Telecare 2002 8(Suppl 

3):S3:22-4. 

Excluded - does not address a key question 

Haegen TW, Cupp CC and Hunsaker DH. 

Teleotolaryngology: a retrospective review at a 

military tertiary treatment facility. Otolaryngol Head 

Neck Surg 2004 May; 130(5):511-8. Excluded - 

wrong population 

Hagan L, Morin D and Lepine R. Evaluation of 

telenursing outcomes: satisfaction, self-care practices, 

and cost savings. Public Health Nurs 2000 17(4):305-

13. 

Excluded - does not address a key question 

Hall JA and Huber DL. Telephone management in 

substance abuse treatment. Telemedicine Journal & E 

Health 2000 6(4):401-7. 

Excluded - contains no or inadequate data 

Hansson KS, Allebeck P and Malm U. Event 

recording in psychiatric care: development of an 

instrument and 1-year results. Nord J Psychiatry 2001 

55(1):25-31. 

Excluded - contains no or inadequate data 

Harley J, McLaren P, Blackwood G, et al. The use of 

videoconferencing to enhance tertiary mental health 

service provision to the island of Jersey. J Telemed 

Telecare 2002 8(Suppl 2):36-8. 

Excluded - contains no or inadequate data 

Harno K, Arajarvi E, Paavola T, et al. Clinical 

effectiveness and cost analysis of patient referral by 

videoconferencing in orthopaedics. J Telemed 

Telecare 2001 7(4):219-25. 

Excluded - contains no or inadequate data 

Harno K, Paavola T, Carlson C, et al. Patient referral 

by telemedicine: effectiveness and cost analysis of an 

Intranet system. J Telemed Telecare 2000 6(6):320-9. 

Excluded - does not address a key question 

Harper DM, Moncur MM, Harper WH, et al. The 

technical performance and clinical feasibility of 

telecolposcopy. J Fam Pract 2000 49(7):623-7. 

Excluded - no comparison group 

Hashimoto S, Shirato H, Kaneko K, et al. Clinical 

efficacy of telemedicine in emergency radiotherapy 

for malignant spinal cord compression. Journal of 

Digital Imaging 2001 Sep; 14(3):124-30. 

Excluded - contains no or inadequate data 

Hatzakis M, Jr., Haselkorn J, Williams R, et al. 

Telemedicine and the delivery of health services to 

veterans with multiple sclerosis. J Rehabil Res Dev 

2003 May-Jun; 40(3):265-82. 

Excluded - wrong population 

Hauber RP and Jones ML. Telerehabilitation support 

for families at home caring for individuals in 

prolonged states of reduced consciousness. J Head 

Trauma Rehabil 2002 Dec; 17(6):535-41. 

Excluded - contains no or inadequate data 

Helveston EM, Orge FH, Naranjo R, et al. 

Telemedicine: Strabismus e-consultation. J Aapos 

2001 Oct; 5(5):291-6. 

Excluded - contains no or inadequate data 

High WA, Houston MS, Calobrisi SD, et al. 

Assessment of the accuracy of low-cost store-andforward teledermatology consultation. Journal of the 

American Academy of Dermatology 2000 42(5 Pt 

1):776-83. 

Excluded - included in previous report 

Hildebrand R, Chow H, Williams C, et al. Feasibility 

of neuropsychological testing of older adults via 

videoconference: implications for assessing the 

capacity for independent living. J Telemed Telecare 

2004 10(3):130-4. 

Excluded - does not meet our definition of 

telemedicine 

Hill JV, Allman LR and Ditzler TF. Utility of realtime video teleconferencing in conducting family 

mental health sessions: two case reports. Telemed J E 

Health 2001 Spring; 7(1):55-9. 

Excluded - contains no or inadequate data 

Hilty DM, Luo JS, Morache C, et al. Telepsychiatry: 

an overview for psychiatrists. CNS Drugs 2002 

16(8):527-48. 

Excluded - does not address a key question 

Hilty DM, Marks SL, Urness D, et al. Clinical and 

educational telepsychiatry applications: a review.[see 

comment]. Can J Psychiatry 2004 Jan; 49(1):12-23. 

Excluded - does not address a key question 

Hilty DM, Nesbitt TS, Canning RD, et al. 

Telepsychiatry for the management of a liver 

transplantation candoesate in the primary care setting. 

Gen Hosp Psychiatry 2000 22(2):122-3. 

Excluded - contains no or inadequate data 

Hilty DM, Sison JI, Nesbitt TS, et al. Telepsychiatric 

consultation for ADHD in the primary care setting. J 

Am Acad Child Adolesc Psychiatry 2000 39(1):15-6. 

Excluded - wrong population 

Hui E and Woo J. Telehealth for older patients: the 

Hong Kong experience. J Telemed Telecare 2002 

8(Suppl 3):S3:39-41. 

Excluded - does not address a key question 

Hui E, Woo J, Hjelm M, et al. Telemedicine: a pilot 

study in nursing home residents. Gerontology 2001 

Mar-Apr; 47(2):82-7. 

Excluded - contains no or inadequate data 
D-11

Hunkeler EM, Meresman JF, Hargreaves WA, et al. 

Efficacy of nurse telehealth care and peer support in 

augmenting treatment of depression in primary 

care.[see comment][comment]. Archives of Family 

Medicine 2000 9(8):700-8. 

Excluded - does not meet our definition of 

telemedicine 

Jacklin PB, Roberts JA, Wallace P, et al. Virtual 

outreach: economic evaluation of joint 

teleconsultations for patients referred by their general 

practitioner for a specialist opinion. Bmj 2003 Jul 12; 

327(7406):84. 

Excluded - does not address a key question 

Jacobsen SE, Sprenger T, Andersson S, et al. 

Neuropsychological assessment and telemedicine: a 

preliminary study examining the reliability of 

neuropsychology services performed via 

telecommunication. J Int Neuropsychol Soc 2003 Mar; 

9(3):472-8. 

Excluded - does not address a key question 

Jamara RJ, Denial A, Valentini D, et al. Clinical 

quality assessment using computer monitor 

photoimages of optic nerve head cupping. Optometry 

& Vision Science 2000 77(8):433-6. 

Excluded - does not address a key question 

Jian G, Mao J and Jiang J. Telediagnosis of 168 cases 

of renal disease. J Telemed Telecare 2002 8(6):360-1. 

Excluded - no comparison group 

Jithoo R, Govender PV, Corr P, et al. Telemedicine 

and neurosurgery: experience of a regional unit based 

in South Africa. J Telemed Telecare 2003 9(2):63-6. 

Excluded - contains no or inadequate data 

Johanson M, Gustafsson M and Johansson LA. A 

remote auscultation tool for advanced home healthcare. J Telemed Telecare 2002 8(Suppl 2):45-7. 

Excluded - contains no or inadequate data 

Johnston D and Jones BN, 3rd. Telepsychiatry 

consultations to a rural nursing facility: a 2-year 

experience. J Geriatr Psychiatry Neurol 2001 Summer; 

14(2):72-5. 

Excluded - no comparison group 

Jones BN, 3rd, Johnston D, Reboussin B, et al. 

Reliability of telepsychiatry assessments: subjective 

versus observational ratings.[see comment]. J Geriatr 

Psychiatry Neurol 2001 Summer; 14(2):66-71. 

Excluded - contains no or inadequate data 

Jones D, Gill P, Harrison R, et al. An exploratory 

study of language interpretation services provided by 

videoconferencing. J Telemed Telecare 2003 9(1):51-

6. 

Excluded - does not address a key question 

Kaufman DR, Patel VL, Hilliman C, et al. Usability in 

the real world: assessing medical information 

technologies in patients' homes. J Biomed Inform 

2003 Feb-Apr; 36(1-2):45-60. 

Excluded - does not address a key question 

Kawasaki S, Ito S, Satoh S, et al. Use of telemedicine 

in periodic screening of diabetic retinopathy. Telemed 

J E Health 2003 Fall; 9(3):235-9. 

Excluded - does not address a key question 

Kennedy C, Blignault I, Hornsby D, et al. 

Videoconferencing in the Queensland health service. J 

Telemed Telecare 2001 7(5):266-71. 

Excluded - does not address a key question 

Kennedy C, Kirwan J, Cook C, et al. Telemedicine 

techniques can be used to facilitate the conduct of 

multicentre trials. J Telemed Telecare 2000 6(6):343-

7. 

Excluded - does not address a key question 

Kennedy C, Van Heerden A, Cook C, et al. Utilization 

and practical aspects of tele-ophthalmology between 

South Africa and the UK. J Telemed Telecare 2001 

7(Suppl 1):20-2. 

Excluded - contains no or inadequate data 

Kennedy C and Yellowlees P. A community-based 

approach to evaluation of health outcomes and costs 

for telepsychiatry in a rural population: preliminary 

results. J Telemed Telecare 2000 6(1) 

Excluded - contains no or inadequate data 

Kenwright M and Marks IM. Computer-aided selfhelp for phobia/panic via internet at home: a pilot 

study. Br J Psychiatry 2004 May; 184:448-9. 

Excluded - no comparison group 

Kerner R, Yogev Y, Belkin A, et al. Maternal selfadministered fetal heart rate monitoring and 

transmission from home in high-risk pregnancies. Int J 

Gynaecol Obstet 2004 Jan; 84(1):33-9. 

Excluded - wrong population 

Kirkwood KT, Peck DF and Bennie L. The 

consistency of neuropsychological assessments 

performed via telecommunication and face to face. J 

Telemed Telecare 2000 6(3):147-51. 

Excluded - included in previous report 

Kiuru MJ, Paakkala TA, Kallio TT, et al. Effect of 

teleradiology on the diagnosis, treatment and 

prognosis of patients in a primary care centre. J 

Telemed Telecare 2002 8(1):25-31. 

Excluded - no comparison group 

Kobza L and Scheurich A. The impact of telemedicine 

on outcomes of chronic wounds in the home care 

setting. Ostomy Wound Management 2000 46(10):48-

53. 

Excluded - no comparison group 
D-12

Korhonen I, Iivainen T, Lappalainen R, et al. TERVA: 

system for long-term monitoring of wellness at home. 

Telemed J E Health 2001 Spring; 7(1):61-72. 

Excluded - contains no or inadequate data 

Kornowski R, Zlochiver S, Botzer L, et al. Validation 

of vital signs recorded via a new telecare system. J 

Telemed Telecare 2003 9(6):328-33. Excluded - 

contains no or inadequate data 

Kruger DF, White K, Galpern A, et al. Effect of 

modem transmission of blood glucose data on 

telephone consultation time, clinic work flow, and 

patient satisfaction for patients with gestational 

diabetes mellitus. J Am Acad Nurse Pract 2003 Aug; 

15(8):371-5. 

Excluded - wrong population 

Krupinski E, Barker G, Rodriguez G, et al. 

Telemedicine versus in-person dermatology referrals: 

an analysis of case complexity. Telemed J E Health 

2002 Summer; 8(2):143-7. 

Excluded - does not address a key question 

Krupinski EA, Barker G, Lopez AM, et al. An 

analysis of unsuccessful teleconsultations. J Telemed 

Telecare 2004 10(1):6-10. 

Excluded - does not address a key question 

Krupinski EA, Engstrom M, Barker G, et al. The 

challenges of following patients and assessing 

outcomes in teledermatology. J Telemed Telecare 

2004 10(1):21-4. 

Excluded - contains no or inadequate data 

Labiris G, Coertzen I, Katsikas A, et al. An eight-year 

study of internet-based remote medical counselling. J 

Telemed Telecare 2002 8(4):222-5. 

Excluded - does not address a key question 

Labiris G, Fanariotis M, Christoulakis C, et al. Teleophthalmology and conventional ophthalmology using 

a mobile medical unit in remote Greece. J Telemed 

Telecare 2003 9(5):296-9. 

Excluded - does not address a key question 

Labiris G, Papadopoulis G, Lentaris G, et al. Internet 

based counseling to remote orthopedic patients. Acta 

Orthop Scand 2004 Jun; 75(3):366-7. 

Excluded - does not address a key question 

Ladyzynski P, Wojcicki JM, Krzymien J, et al. 

Teletransmission system supporting intensive insulin 

treatment of out-clinic type 1 diabetic pregnant 

women. Technical assessment during 3 years' 

application. Int J Artif Organs 2001 Mar; 24(3):157-

63. 

Excluded - wrong population 

Lahtela JT and Lamminen H. Telemedical devices in 

diabetes management. Ann Med 2002 34(4):241-7. 

Excluded - does not address a key question 

Lamminen H, Lamminen J, Ruohonen K, et al. A cost 

study of teleconsultation for primary-care 

ophthalmology and dermatology. J Telemed Telecare 

2001 7(3):167-73. 

Excluded - does not address a key question 

Lamminen H, Tuomi ML, Lamminen J, et al. A 

feasibility study of realtime teledermatology in 

Finland. J Telemed Telecare 2000 6(2):102-7. 

Excluded - contains no or inadequate data 

Lange A, van de Ven JP, Schrieken BA, et al. Internetmediated, protocol-driven treatment of psychological 

dysfunction. J Telemed Telecare 2000 6(1):15-21. 

Excluded - contains no or inadequate data 

Lankford DA. Wireless CPAP patient monitoring: 

accuracy study. Telemed J E Health 2004 Summer; 

10(2):162-9. 

Excluded - does not address a key question 

Lateef F and Anantharaman V. Maritime radiomedical services: the Singapore General Hospital 

experience. Am J Emerg Med 2002 Jul; 20(4):349-51. 

Excluded - does not address a key question 

Lau C, Churchill RS, Kim J, et al. Asynchronous webbased patient-centered home telemedicine system. 

IEEE Trans Biomed Eng 2002 Dec; 49(12):1452-62. 

Excluded - contains no or inadequate data 

Lee BR, Png DJ, Liew L, et al. Laparoscopic 

telesurgery between the United States and Singapore. 

Annals of the Academy of Medicine, Singapore 2000 

29(5):665-8. 

Excluded - does not address a key question 

Lee JH, Kim JH, Jhoo JH, et al. A telemedicine 

system as a care modality for dementia patients in 

Korea. Alzheimer Disease & Associated Disorders 

2000 14(2):94-101. 

Excluded - contains no or inadequate data 

Leifer D. Net gains for health. Nurs Stand 2003 May 

28-Jun 3; 17(37):16-8. 

Excluded - does not address a key question 

Leonard S. The development and evaluation of a 

telepsychiatry service for prisoners. J Psychiatr Ment 

Health Nurs 2004 Aug; 11(4):461-8. 

Excluded - wrong population 

Leong FJ, Nicholson AG and McGee JO. Robotic 

telepathology: efficacy and usability in pulmonary 

pathology. J Pathol 2002 Jun; 197(2):211-7. 

Excluded - does not address a key question 

Lessing K and Blignault I. Mental health telemedicine 

programmes in Australia. J Telemed Telecare 2001 

7(6):317-23. 
D-13

Excluded - does not address a key question 

Lester J, Prady S, Finegan Y, et al. Learning from epatients at Massachusetts General Hospital. Bmj 2004 

May 15; 328(7449):1188-90. 

Excluded - does not address a key question 

Lieder TR. Telemedicine company brings ICU 

patients to the physician. American Journal of Health 

System Pharmacy 2000 57(24):2246-7. 

Excluded - contains no or inadequate data 

Lim AC, See AC and Shumack SP. Progress in 

Australian teledermatology. J Telemed Telecare 2001 

7(Suppl 2):55-9. 

Excluded - contains no or inadequate data 

Lin CC, Bai Y and Chen JY. Reliability of 

information provided by patients of a virtual 

psychiatric clinic. Psychiatr Serv 2003 Aug; 

54(8):1167-8. 

Excluded - does not address a key question 

Lin CC, Chen HS, Chen CY, et al. Implementation 

and evaluation of a multifunctional telemedicine 

system in NTUH. Int J Med Inf 2001 May; 61(2-

3):175-87. 

Excluded - does not address a key question 

Lin DY, Blumenkranz MS, Brothers RJ, et al. The 

sensitivity and specificity of single-field nonmydriatic 

monochromatic digital fundus photography with 

remote image interpretation for diabetic retinopathy 

screening: a comparison with ophthalmoscopy and 

standardized mydriatic color photography.[see 

comment]. Am J Ophthalmol 2002 Aug; 134(2):204-

13. 

Excluded - does not address a key question 

Liu L and Miyazaki M. Telerehabilitation at the 

University of Alberta. J Telemed Telecare 2000 6(2) 

Excluded - contains no or inadequate data 

Loane MA, Bloomer SE, Corbett R, et al. A 

randomized controlled trial assessing the health 

economics of realtime teledermatology compared with 

conventional care: an urban versus rural perspective. J 

Telemed Telecare 2001 7(2):108-18. 

Excluded - does not address a key question 

Loane MA, Bloomer SE, Corbett R, et al. A 

comparison of real-time and store-and-forward 

teledermatology: a cost-benefit study. Br J Dermatol 

143(6):1241-7. 

Excluded - no comparison group 

Loane MA, Bloomer SE, Corbett R, et al. A 

randomized controlled trial to assess the clinical 

effectiveness of both realtime and store-and-forward 

teledermatology compared with conventional care. J 

Telemed Telecare 2000 6(1) 

Excluded - included in previous report 

Loh PK, Ramesh P, Maher S, et al. Can patients with 

dementia be assessed at a distance? The use of 

Telehealth and standardised assessments. Intern Med J 

2004 May; 34(5):239-42. 

Excluded - does not address a key question 

Louis AA, Turner T, Gretton M, et al. A systematic 

review of telemonitoring for the management of heart 

failure. Eur J Heart Fail 2003 Oct; 5(5):583-90. 

Excluded - contains no or inadequate data 

Lowry J. The development of a telemedicine system 

for a centralized maxillofacial unit serving four towns. 

J Telemed Telecare 2001 7(Suppl 1):58-9. 

Excluded - does not address a key question 

Luethi U, Risch L, Korte W, et al. Telehematology: 

critical determinants for successful implementation. 

Blood 2004 Jan 15; 103(2):486-8. 

Excluded - contains no or inadequate data 

Lyketsos CG, Roques C, Hovanec L, et al. 

Telemedicine use and the reduction of psychiatric 

admissions from a long-term care facility. J Geriatr 

Psychiatry Neurol 2001 Summer; 14(2):76-9. 

Excluded - contains no or inadequate data 

Lynch J, Weaver L, Hall P, et al. Using telehealth 

technology to support CME in end-of-life care for 

community physicians in Ontario. Telemed J E Health 

2004 Spring; 10(1):103-7. 

Excluded - contains no or inadequate data 

Macduff C, West B and Harvey S. Telemedicine in 

rural care. Part 1: Developing and evaluating a nurseled initiative. Nurs Stand 2001 Apr 25-May 1; 

15(32):33-8. 

Excluded - does not address a key question 

Macduff C, West B and Harvey S. Telemedicine in 

rural care. Part 2: Assessing the wider issues. Nurs 

Stand 2001 May 2-8; 15(33):33-7. 

Excluded - does not address a key question 

MacFarlane A, Harrison R and Wallace P. The 

benefits of a qualitative approach to telemedicine 

research. J Telemed Telecare 2002 8(Suppl 2):56-7. 

Excluded - does not address a key question 

Mair F, Boland A, Angus R, et al. A randomized 

controlled trial of home telecare. J Telemed Telecare 

2002 8(Suppl 2):58-60. 

Excluded - contains no or inadequate data 

Malone F, Callahan CW, Chan DS, et al. Caring for 

children with asthma through teleconsultation: 

"ECHO-Pac, The Electronic Children's Hospital of the 

Pacific". Telemed J E Health 2004 Summer; 

10(2):138-46. 

Excluded - wrong population 
D-14

Mann T and Colven R. A picture is worth more than a 

thousand words: enhancement of a pre-exam 

telephone consultation in dermatology with digital 

images. Acad Med 2002 Jul; 77(7):742-3. 

Excluded - contains no or inadequate data 

Mantzouranis EC. User friendliness aspects of home 

care telematics. Methods Inf Med 2002 41(5):370-5. 

Excluded - does not address a key question 

Marchevsky AM, Lau SK, Khanafshar E, et al. 

Internet teleconferencing method for telepathology 

consultations from lung and heart transplant patients. 

Hum Pathol 2002 Apr; 33(4):410-4. 

Excluded - does not address a key question 

Marcin JP, Nesbitt TS, Kallas HJ, et al. Use of 

telemedicine to provide pediatric critical care inpatient 

consultations to underserved rural Northern California. 

J Pediatr 2004 Mar; 144(3):375-80. 

Excluded - wrong population 

Maree DM, Videler EA, Hallauer M, et al. 

Comparison of a new desktop spirometer (Diagnosa) 

with a laboratory spirometer. Respiration 2001 

68(4):400-4. 

Excluded - does not address a key question 

Marietti C. Healthcare innovations in technology 

systems. Telehealth in the city. The Charles R. Drew 

University-Nortel partnership delivers quality 

healthcare to an urban neighborhood. Healthcare 

Informatics 2001 Jun; 18(6):97-8. 

Excluded - does not address a key question 

Marks IM, Kenwright M, McDonough M, et al. 

Saving clinicians' time by delegating routine aspects 

of therapy to a computer: a randomized controlled trial 

in phobia/panic disorder. Psychol Med 2004 Jan; 

34(1):9-17. 

Excluded - does not address a key question 

Martin EM, Coyle MK, Warden DL, et al. Telephonic 

nursing in traumatic brain injury. Am J Nurs 2003 

Oct; 103(10):75-81. 

Excluded - does not address a key question 

Martin S and Rankin G. Using commercially available 

technology to assist in the delivery of person-centred 

health and social care. J Telemed Telecare 2002 

8(Suppl 2):60-2. 

Excluded - contains no or inadequate data 

Mathewson C, Adkins VK and Jones ML. Initial 

experiences with telerehabilitation and contingency 

management programs for the prevention and 

management of pressure ulceration in patients with 

spinal cord injuries. J Wound Ostomy Continence 

Nurs 2000 27(5):269-71. 

Excluded - contains no or inadequate data 

Mattson S, Shearer N and Long C. Exploring 

telehealth opportunities in domestic violence shelters. 

J Am Acad Nurse Pract 2002 Oct; 14(10):465-70. 

Excluded - contains no or inadequate data 

Mavrogeni SI, Tsirintani M, Kleanthous C, et al. 

Supervision of thrombolysis of acute myocardial 

infarction using telemedicine. J Telemed Telecare 

2000 6(1):54-8. 

Excluded - contains no or inadequate data 

May C, Gask L, Ellis N, et al. Telepsychiatry 

evaluation in the north-west of England: preliminary 

results of a qualitative study. J Telemed Telecare 2000 

6(1) 

Excluded - contains no or inadequate data 

Mbao MN, Eikelboom RH, Atlas MD, et al. 

Evaluation of video-otoscopes suitable for teleotology. Telemed J E Health 2003 Winter; 9(4):325-

30. 

Excluded - contains no or inadequate data 

McCafferty M, Sorbellini D and Cianci P. Telemetry 

to home: successful discharge of patients with 

ventricular assist devices. Crit Care Nurse 2002 Jun; 

22(3):43-51. 

Excluded - contains no or inadequate data 

McGauran A. Telemedicine. Straight to video. Health 

Service Journal 2003 Jul 31; 113(5866):26-7. 

Excluded - contains no or inadequate data 

McIntosh A and Thie J. The development of a new 

model for community telemedicine services. J 

Telemed Telecare 2001 7(Suppl 1):69-72. 

Excluded - does not address a key question 

McKinstry B, Walker J, Campbell C, et al. Telephone 

consultations to manage requests for same-day 

appointments: a randomised controlled trial in two 

practices. Br J Gen Pract 2002 Apr; 52(477):306-10. 

Excluded - does not meet our definition of 

telemedicine 

McLaren P, Ahlbom J, Riley A, et al. The North 

Lewisham telepsychiatry project: beyond the pilot 

phase. J Telemed Telecare 2002 8(Suppl 2):98-100. 

Excluded - contains no or inadequate data 

Meade B and Barnett P. Emergency care in a remote 

area using interactive video technology: a study in 

prehospital telemedicine. J Telemed Telecare 2002 

8(2):115-7. 

Excluded - does not address a key question 

Melcer T, Crann B, Hunsaker D, et al. A retrospective 

evaluation of the development of a telemedicine 

network in a military setting. Mil Med 2002 Jun; 

167(6):510-5. 

Excluded - wrong population 
D-15

Melcer T, Hunsaker D, Crann B, et al. A prospective 

evaluation of ENT telemedicine in remote military 

populations seeking specialty care. Telemed J E 

Health 2002 Fall; 8(3):301-11. 

Excluded - contains no or inadequate data 

Mengden T, Vetter H, Tisler A, et al. Tele-monitoring 

of home blood pressure. Blood Press Monit 2001 Aug; 

6(4):185-9. 

Excluded - does not address a key question 

Michelson G, Striebel W, Prihoda W, et al. 

Telemedicine in the control of intra-ocular pressure. J 

Telemed Telecare 2000 6(1) 

Excluded - contains no or inadequate data 

Mielonen ML, Vaisanen L, Moring J, et al. 

Implementation of a telepsychiatric network in 

northern Finland. Aktuelle Probl Dermatol 2003 

32:132-40. 

Excluded - does not address a key question 

Miller EA. Telemedicine and doctor-patient 

communication: an analytical survey of the literature. 

J Telemed Telecare 2001 7(1):1-17. 

Excluded - does not address a key question 

Miller GG and Levesque K. Telehealth provides 

effective pediatric surgery care to remote locations. J 

Pediatr Surg 2002 May; 37(5):752-4. 

Excluded - wrong population 

Miloud GL. Response to: Heartcare: an Internet-based 

information and support system for patient home 

recovery after coronary artery bypass graft (CABG) 

surgery by P. Flatley Brennan, S.M. Moore, G. 

Bjornsdottir, J. Jones, C. Visovsky and M. Rogers 

(2001) Journal Of Advanced Nursing 35, 699-

708.[comment]. J Adv Nurs 2002 May; 38(4):425; 

author reply 425-6. 

Excluded - does not address a key question 

Mitchell JG, Disney AP and Roberts M. Renal 

telemedicine to the home. J Telemed Telecare 2000 

6(1):59-62. 

Excluded - contains no or inadequate data 

Miyashita T, Takizawa M, Nakai K, et al. Realtime 

ultrasound screening by satellite telecommunication. J 

Telemed Telecare 2003 9(Suppl 1):S60-1. 

Excluded - does not address a key question 

Miyashita T, Takizawa M, Nakai K, et al. 

Telemedicine of the heart: real-time telescreening of 

echocardiography using satellite telecommunication. 

Circ J 2003 Jun; 67(6):562-4. 

Excluded - does not address a key question 

Miyazaki M, Stuart M, Liu L, et al. Use of ISDN 

video-phones for clients receiving palliative and 

antenatal home care. J Telemed Telecare 2003 

9(2):72-7. 

Excluded - does not address a key question 

Mizushima H, Uchiyama E, Nagata H, et al. Japanese 

experience of telemedicine in oncology. Int J Med Inf 

2001 May; 61(2-3):207-15. 

Excluded - does not address a key question 

Molinari G, Reboa G, Frascio M, et al. The role of 

telecardiology in supporting the decision-making 

process of general practitioners during the 

management of patients with suspected cardiac events. 

J Telemed Telecare 2002 8(2):97-101. 

Excluded - does not address a key question 

Moller DS, Doeseriksen A, Sorensen S, et al. 

Accuracy of telemedical home blood pressure 

measurement in the diagnosis of hypertension. J Hum 

Hypertens 2003 Aug; 17(8):549-54. 

Excluded - does not address a key question 

Moller DS, Doeseriksen A, Sorensen S, et al. Telemonitoring of home blood pressure in treated 

hypertensive patients. Blood Press 2003 12(1):56-62. 

Excluded - does not address a key question 

Montani S, Bellazzi R, Quaglini S, et al. Meta-analysis 

of the effect of the use of computer-based systems on 

the metabolic control of patients with diabetes 

mellitus. Diabetes Technol Ther 2001 Fall; 3(3):347-

56. 

Excluded - does not address a key question 

Montironi R, Thompson D, Scarpelli M, et al. 

Transcontinental communication and quantitative 

digital histopathology via the Internet; with special 

reference to prostate neoplasia. J Clin Pathol 2002 

Jun; 55(6):452-60. 

Excluded - does not address a key question 

Morrison J, Bergauer NK, Jacques D, et al. 

Telemedicine: cost-effective management of high-risk 

pregnancy. Manag Care 2001 Nov; 10(11):42-6, 48-9. 

Excluded - wrong population 

Mueller TM, Vuckovic KM, Knox DA, et al. 

Telemanagement of heart failure: a diuretic treatment 

algorithm for advanced practice nurses. Heart Lung 

2002 Sep-Oct; 31(5):340-7. 

Excluded - does not address a key question 

Mukundan S, Jr., Vydareny K, Vassallo DJ, et al. Trial 

telemedicine system for supporting medical students 

on elective in the developing world. Acad Radiol 2003 

Jul; 10(7):794-7. 

Excluded - does not address a key question 

Murdoch I, Bainbridge J, Taylor P, et al. Postoperative 

evaluation of patients following ophthalmic surgery. J 

Telemed Telecare 2000 6(1) 

Excluded - contains no or inadequate data 
D-16

Murphy JC. Telemedicine offers new way to manage 

asthma. Am J Health Syst Pharm 2001 Sep 15; 

58(18):1693, 1696. 

Excluded - contains no or inadequate data 

Nakagawa A, Marks IM, Park JM, et al. Self-treatment 

of obsessive-compulsive disorder guided by manual 

and computer-conducted telephone interview. J 

Telemed Telecare 2000 6(1):22-6. 

Excluded - does not meet our definition of 

telemedicine 

Nakajima I, Juzoji H, Wijarnpreecha S, et al. The final 

report of the project 'AMINE' the Asia Pacific Medical 

Information Network using with ETS-V. Int J Med Inf 

2001 May; 61(2-3):87-96. 

Excluded - does not address a key question 

Nakamoto H, Hatta M, Tanaka A, et al. Telemedicine 

system for home automated peritoneal dialysis. 

Advances in Peritoneal Dialysis 2000 16:191-4. 

Excluded - contains no or inadequate data 

Nakamoto H, Kawamoto A, Tanabe Y, et al. 

Telemedicine system using a cellular telephone for 

continuous ambulatory peritoneal dialysis patients. 

Advances in Peritoneal Dialysis 2003 19:124-9. 

Excluded - contains no or inadequate data 

Nelson EL, Barnard M and Cain S. Treating childhood 

depression over videoconferencing. Telemed J E 

Health 2003 Spring; 9(1):49-55. 

Excluded - wrong population 

Niiranen S and Lamminen H. Feasibility of personal 

prothrombin time measurement in anticoagulant 

treatment follow-up. J Telemed Telecare 2002 

8(6):359-60. 

Excluded - contains no or inadequate data 

Niiranen S, Lamminen H, Mattila H, et al. Personal 

health care services through digital television. Comput 

Methods Programs Biomed 2002 Jun; 68(3):249-59. 

Excluded - does not address a key question 

Niiranen S, Lamminen H, Niemi K, et al. A cost study 

of new media supported near oral anticoagulant 

treatment follow-up. Int J Med Inf 2003 Apr; 

70(1):19-29. 

Excluded - does not address a key question 

Norris TE, Hart GL, Larson EH, et al. Lowbandwidth, low-cost telemedicine consultations in 

rural family practice.[see comment]. J Am Board Fam 

Pract 2002 Mar-Apr; 15(2):123-7. 

Excluded - does not address a key question 

Nowakowski R and Hammack G. Ophthalmic 

telemedicine at the Alabama Institute for Deaf and 

Blind. Optometry (St Louis, Mo ) 2001 Jan; 72(1):8-

12. 

Excluded - contains no or inadequate data 

Oakley AM. Teledermatology in New Zealand. J 

Cutan Med Surg 2001 Mar-Apr; 5(2):111-6. 

Excluded - contains no or inadequate data 

Oakley AM, Kerr P, Duffill M, et al. Patient costbenefits of realtime teledermatology--a comparison of 

data from Northern Ireland and New Zealand. J 

Telemed Telecare 2000 6(2):97-101. 

Excluded - does not address a key question 

Ogasawara K, Ito K, Jiang G, et al. Preliminary 

clinical evaluation of a video transmission system for 

home visits. J Telemed Telecare 2003 9(5):292-5. 

Excluded - does not address a key question 

Oh JA, Kim HS, Yoon KH, et al. A telephonedelivered intervention to improve glycemic control in 

type 2 diabetic patients. Yonsei Med J 2003 Feb; 

44(1):1-8. 

Excluded - does not address a key question 

Oliveira MR, Wen CL, Neto CF, et al. Web site for 

training nonmedical health-care workers to identify 

potentially malignant skin lesions and for 

teledermatology. Telemed J E Health 2002 Fall; 

8(3):323-32. 

Excluded - does not address a key question 

Olver IN and Selva-Nayagam S. Evaluation of a 

telemedicine link between Darwin and Adelaide to 

facilitate cancer management. Telemedicine Journal 

2000 6(2):213-8. 

Excluded - does not address a key question 

Orlov OI, Levanov VM, Merrell RC, et al. A pilot 

telemedicine project in the Privolzhsky District, 

Russia. Telemed J E Health 2003 Fall; 9(3):291-5. 

Excluded - contains no or inadequate data 

Ostojic V, Stipic-Markovic A, Tudman Z, et al. A 

feasibility study of realtime telemedicine in Croatia 

using Internet videoconferencing. J Telemed Telecare 

2000 6(3):172-6. 

Excluded - does not address a key question 

Paiva T, Coelho H, Almeida A, et al. 

Neuroteleconsultation for general practitioners. 

Studies in Health Technology & Informatics 2000 

78:329-41. 

Excluded - does not address a key question 

Paiva T, Coelho H, Araujo MT, et al. Neurological 

teleconsultation for general practitioners. J Telemed 

Telecare 2001 7(3):149-54. 

Excluded - does not address a key question 

Pak HS. Teledermoscopy: a specific application of 

teledermotology.[comment]. Skinmed 2002 Sep-Oct; 

1(1):18-9. 

Excluded - does not address a key question 
D-17

Pallawala PM and Lun KC. EMR based telegeriatric 

system. Int J Med Inf 2001 May; 61(2-3):229-34. 

Excluded - does not address a key question 

Pallawala PM and Lun KC. EMR-based TeleGeriatric 

system. Medinfo 2001 10(Pt 1):849-53. 

Excluded - contains no or inadequate data 

Palombo A, Ferguson J, Rowlands A, et al. An 

evaluation of a telemedicine fracture review clinic. J 

Telemed Telecare 2003 9(Suppl 1):S31-3. 

Excluded - does not address a key question 

Pandit RB. Role of cardiophone in the pre-hospital 

treatment of acute myocardial infarction. Journal of 

the Association of Physicians of India 2001 Sep; 

49:946. 

Excluded - does not meet our definition of 

telemedicine 

Park DG and Kim HC. Comparative study of 

telecommunication methods for emergency 

telemedicine. J Telemed Telecare 2003 9(5):300-3. 

Excluded - does not address a key question 

Patricoski C and Ferguson AS. ECG acquisition using 

telemedicine in Alaska. Alaska Med 2003 Jul-Sep; 

45(3):60-3. 

Excluded - contains no or inadequate data 

Patricoski C, Kokesh J, Ferguson AS, et al. A 

comparison of in-person examination and video 

otoscope imaging for tympanostomy tube follow-up. 

Telemed J E Health 2003 Winter; 9(4):331-44. 

Excluded - does not address a key question 

Patten SB. Prevention of depressive symptoms 

through the use of distance technologies. Psychiatr 

Serv 2003 Mar; 54(3):396-8. 

Excluded - does not meet our definition of 

telemedicine 

Patterson V. Teleneurology in Northern Ireland: a 

success. J Telemed Telecare 2002 8(Suppl 3):S3:46-7. 

Excluded - does not address a key question 

Patterson V, Hoque F, Vassallo D, et al. Store-andforward teleneurology in developing countries. J 

Telemed Telecare 2001 7(Suppl 1):52-3. 

Excluded - contains no or inadequate data 

Patterson V, Humphreys J and Chua R. Teleneurology 

by email. J Telemed Telecare 2003 9(Suppl 2):S42-3. 

Excluded - does not address a key question 

Patterson VH, Craig JJ and Wootton R. Effective 

diagnosis of spinal cord compression using 

telemedicine. Br J Neurosurg 2000 14(6):552-4. 

Excluded - contains no or inadequate data 

Pearson B, Katz SE, Soucie V, et al. Evidence-based 

care for depression in Maine: dissemination of the 

Kaiser Permanente Nurse Telecare Program. Psychiatr 

Q 2003 Spring; 74(1):91-102. 

Excluded - does not meet our definition of 

telemedicine 

Pedley D, Ferguson J, Palombo A, et al. Community 

coronary units: strategies to promote pre-hospital 

thrombolysis. J Telemed Telecare 2002 8(Suppl 2):24-

5. 

Excluded - does not address a key question 

Pelletier-Fleury N, Gagnadoux F, Philippe C, et al. A 

cost-minimization study of telemedicine. The case of 

telemonitored polysomnography to diagnose 

obstructive sleep apnea syndrome. Int J Technol 

Assess Health Care 2001 Fall; 17(4):604-11. 

Excluded - does not address a key question 

Perlemuter L and Yomtov B. Feasibility and 

usefulness of dedicated software and e-mail for selfmonitoring blood glucose in treating diabetes. Diabet 

Med 2002 Aug; 19(8):701-2. 

Excluded - does not address a key question 

Person DA. Pacific Island Health Care Project: early 

experiences with a Web-based consultation and 

referral network. Pacific Health Dialog 2000 7(2):29-

35. 

Excluded - contains no or inadequate data 

Piccolo D, Peris K, Chimenti S, et al. Jumping into the 

future using teledermoscopy.[see comment]. Skinmed 

2002 Sep-Oct; 1(1):20-4. 

Excluded - contains no or inadequate data 

Pierce LL, Steiner V, Govoni AL, et al. Internet-based 

support for rural caregivers of persons with stroke 

shows promise. Rehabil Nurs 2004 2004 May-Jun; 

29(3):95-9. 

Excluded - does not address a key question 

Piwernetz K. DIABCARE Quality Network in 

Europe--a model for quality management in chronic 

diseases. Int Clin Psychopharmacol 2001 Apr; 

16(Suppl 3):S5-13. 

Excluded - does not address a key question 

Pollard SE and LePage JP. Telepsychiatry in a rural 

inpatient setting. Psychiatr Serv 2001 Dec; 

52(12):1659. 

Excluded - does not address a key question 

Poon WS, Leung CH, Lam MK, et al. The 

comparative impact of video-consultation on 

neurosurgical health services. Int J Med Inf 2001 Jul; 

62(2-3):175-80. 

Excluded - no comparison group 

Port K, Palm K and Viigimaa M. Self-reported 

compliance of patients receiving antihypertensive 

treatment: use of a telemonitoring home care system. J 

Telemed Telecare 2003 9(Suppl 1):S65-6. 
D-18

Excluded - no comparison group 

Prado M, Roa L, Reina-Tosina J, et al. Renal 

telehealthcare system based on a patient physiological 

image: a novel hybrid approach in telemedicine. 

Telemed J E Health 2003 Summer; 9(2):149-65. 

Excluded - does not address a key question 

Reeves PM. Coping in cyberspace: the impact of 

Internet use on the ability of HIV-positive individuals 

to deal with their illness. J Health Commun 2000 5:47-

59. 

Excluded - does not address a key question 

Regnard C. Using videoconferencing in palliative 

care. Palliative Medicine 2000 14(6):519-28. 

Excluded - does not address a key question 

Ricker JH, Rosenthal M, Garay E, et al. 

Telerehabilitation needs: a survey of persons with 

acquired brain injury. J Head Trauma Rehabil 2002 

Jun; 17(3):242-50. 

Excluded - contains no or inadequate data 

Robinson JG, Conroy C and Wickemeyer WJ. A novel 

telephone-based system for management of secondary 

prevention to a low-density lipoprotein cholesterol < 

or = 100 mg/dl. American Journal of Cardiology 2000 

85(3):305-8. 

Excluded - does not meet our definition of 

telemedicine 

Rogers MA, Buchan DA, Small D, et al. Telemedicine 

improves diagnosis of essential hypertension 

compared with usual care. J Telemed Telecare 2002 

8(6):344-9. 

Excluded - does not meet our definition of 

telemedicine 

Romano MJ, Hernandez J, Gaylor A, et al. 

Improvement in asthma symptoms and quality of life 

in pediatric patients through specialty care delivered 

via telemedicine. Telemed J E Health 2001 Winter; 

7(4):281-6. 

Excluded - no comparison group 

Rosenfeld BA, Dorman T, Breslow MJ, et al. 

Intensive care unit telemedicine: alternate paradigm 

for providing continuous intensivist care.[see 

comment]. Crit Care Med 2000 28(12):3925-31. 

Excluded - included in previous report 

Ross MD, Twombly IA, Bruyns C, et al. 

Telecommunications for health care over distance: the 

Virtual Collaborative Clinic. Studies in Health 

Technology & Informatics 2000 70:286-91. 

Excluded - contains no or inadequate data 

Ross SE, Moore LA, Earnest MA, et al. Providing a 

web-based online medical record with electronic 

communication capabilities to patients with congestive 

heart failure: randomized trial.[see comment]. J Med 

Internet Res 2004 May 14; 6(2):e12. 

Excluded - does not address a key question 

Russell TG, Jull GA and Wootton R. The diagnostic 

reliability of Internet-based observational kinematic 

gait analysis. J Telemed Telecare 2003 9(Suppl 

2):S48-51. 

Excluded - no comparison group 

Safran C. The collaborative edge: patient 

empowerment for vulnerable populations. Int J Med 

Inf 2003 Mar; 69(2-3):185-90. 

Excluded - wrong population 

Saligari J, Flicker L, Loh PK, et al. The clinical 

achievements of a geriatric telehealth project in its 

first year. J Telemed Telecare 2002 8(Suppl 3):S3:53-

5. 

Excluded - no comparison group 

Salmon S, Brint G, Marshall D, et al. Telemedicine 

use in two nurse-led minor injuries units. J Telemed 

Telecare 2000 6(1) 

Excluded - contains no or inadequate data 

Sanford JA, Jones M, Daviou P, et al. Using 

telerehabilitation to identify home modification needs. 

Assist Technol 2004 Summer; 16(1):43-53. 

Excluded - does not address a key question 

Savard L, Borstad A, Tkachuck J, et al. 

Telerehabilitation consultations for clients with 

neurologic diagnoses: cases from rural Minnesota and 

American Samoa. NeuroRehabilitation 2003 18(2):93-

102. 

Excluded - contains no or inadequate data 

Scalvini S, Zanelli E, Volterrani M, et al. A pilot study 

of nurse-led, home-based telecardiology for patients 

with chronic heart failure. J Telemed Telecare 2004 

10(2):113-7. 

Excluded - contains no or inadequate data 

Scherrer-Bannerman A, Fofonoff D, Minshall D, et al. 

Web-based education and support for patients on the 

cardiac surgery waiting list. J Telemed Telecare 2000 

6(2) 

Excluded - contains no or inadequate data 

Schmid-Grendelmeier P, Doe P and Pakenham-Walsh 

N. Teledermatology in sub-Saharan Africa. Aktuelle 

Probl Dermatol 2003 32:233-46. 

Excluded - does not address a key question 

Schopp LH, Johnstone BR and Merveille OC. 

Multidimensional telecare strategies for rural residents 

with brain injury. J Telemed Telecare 2000 6(1) 

Excluded - does not address a key question 

Setterberg SR, Busseri MA, Fleissner RM, et al. 

Remote assessment of the use of seclusion and 
D-19

restraint with paediatric psychiatric patients. J 

Telemed Telecare 2003 9(3):176-9. 

Excluded - wrong population 

Sezeur A, Degramont A, Touboul E, et al. 

Teleconsultation before chemotherapy for recently 

operated on patients. American Journal of Surgery 

2001 Jul; 182(1):49-51. 

Excluded - contains no or inadequate data 

Shannon G, Nesbitt T, Bakalar R, et al. 

Telemedicine/telehealth: an international perspective. 

Organizational models of telemedicine and regional 

telemedicine networks. Telemed J E Health 2002 

Spring; 8(1):61-70. 

Excluded - does not address a key question 

Sicotte C and Lehoux P. Teleconsultation: rejected 

and emerging uses. Methods Inf Med 2003 42(4):451-

7. 

Excluded - does not address a key question 

Sicotte C, Lehoux P, Fortier-Blanc J, et al. Feasibility 

and outcome evaluation of a telemedicine application 

in speech-language pathology. J Telemed Telecare 

2003 9(5):253-8. 

Excluded - no comparison group 

Simpson J, Doze S, Urness D, et al. Telepsychiatry as 

a routine service--the perspective of the patient. J 

Telemed Telecare 2001 7(3):155-60. 

Excluded - does not address a key question 

Sing A, Salzman J and Sing D. Problems and risks of 

unsolicited e-mails in patient-physician encounters in 

travel medicine settings. J Travel Med 2001 May-Jun; 

8(3):109-12. 

Excluded - does not address a key question 

Sixsmith AJ. An evaluation of an intelligent home 

monitoring system. J Telemed Telecare 2000 6(2):63-

72. 

Excluded - contains no or inadequate data 

Smith AC, Batch J, Lang E, et al. The use of online 

health techniques to assist with the delivery of 

specialist paediatric diabetes services in Queensland. J 

Telemed Telecare 2003 9(Suppl 2):S54-7. 

Excluded - wrong population 

Smith AC, Isles A, McCrossin R, et al. The point-ofreferral barrier--a factor in the success of telehealth. J 

Telemed Telecare 2001 7(Suppl 2):75-8. 

Excluded - wrong population 

Smith AC, Kairl JA and Kimble R. Post-acute care for 

a paediatric burns patient in regional Queensland. J 

Telemed Telecare 2002 8(5):302-4. 

Excluded - wrong population 

Smith AC, Williams M, Van der Westhuyzen J, et al. 

A comparison of telepaediatric activity at two regional 

hospitals in Queensland. J Telemed Telecare 2002 

8(Suppl 3):S3:58-62. 

Excluded - wrong population 

Stalfors J, Edstrom S, Bjork-Eriksson T, et al. 

Accuracy of tele-oncology compared with face-to-face 

consultation in head and neck cancer case conferences. 

J Telemed Telecare 2001 7(6):338-43. 

Excluded - no comparison group 

Steel S, Lock S, Johnson N, et al. A feasibility study 

of remote monitoring of asthmatic patients. J Telemed 

Telecare 2002 8(5):290-6. 

Excluded - contains no or inadequate data 

Stormo A, Sollid S, Stormer J, et al. Neurosurgical 

teleconsultations in northern Norway. J Telemed 

Telecare 2004 10(3):135-9. 

Excluded - does not address a key question 

Stroetmann KA, Gruetzmacher P and Stroetmann VN. 

Improving quality of life for dialysis patients through 

telecare. J Telemed Telecare 2000 6(1) 

Excluded - does not address a key question 

Sumner CR. Telepsychiatry: challenges in rural aging. 

J Rural Health 2001 Fall; 17(4):370-3. 

Excluded - contains no or inadequate data 

Tachakra S. Depth perception in telemedical 

consultations. Telemed J E Health 2001 Summer; 

7(2):77-85. 

Excluded - does not address a key question 

Tachakra S, Dutton D, Newson R, et al. How do 

teleconsultations for remote trauma management 

change over a period of time? J Telemed Telecare 

2000 6(1) 

Excluded - contains no or inadequate data 

Tachakra S, Jaye P, Bak J, et al. Supervising trauma 

life support by telemedicine. J Telemed Telecare 2000 

6(1) 

Excluded - does not address a key question 

Tachakra S, Loane M and Uche CU. A follow-up 

study of remote trauma teleconsultations. J Telemed 

Telecare 2000 6(6):330-4. 

Excluded - no comparison group 

Tachakra S, Lynch M, Newson R, et al. A comparison 

of telemedicine with face-to-face consultations for 

trauma management. J Telemed Telecare 2000 6(1) 

Excluded - included in previous report 

Taylor P. An assessment of the potential effect of a 

teledermatology system. J Telemed Telecare 2000 

6(1) 

Excluded - contains no or inadequate data 

Tennant MT, Greve MD, Rudnisky CJ, et al. 

Identification of diabetic retinopathy by stereoscopic 
D-20

digital imaging via teleophthalmology: a comparison 

to slide film. Can J Ophthalmol 2001 Jun; 36(4):187-

96. 

Excluded - does not address a key question 

Theodoros D, Russell TG, Hill A, et al. Assessment of 

motor speech disorders online: a pilot study. J 

Telemed Telecare 2003 9(Suppl 2):S66-8. 

Excluded - no comparison group 

Thorley PJ, Beacock DJ, Trickett CA, et al. 18FDG 

SPECT to assess myocardial viability: initial 

experience at a hospital remote from a cyclotron. 

Nuclear Medicine Communications 2000 21(8):715-8. 

Excluded - does not address a key question 

Ting HH, Garratt KN, Singh M, et al. Low-risk 

percutaneous coronary interventions without on-site 

cardiac surgery: two years' observational experience 

and follow-up.[see comment]. American Heart Journal 

2003 Feb; 145(2):278-84. 

Excluded - does not address a key question 

Tomuro K. Development of oral home telecare 

programme for the home-dwelling elderly: a pilot 

study. Gerodontology 2004 Sep; 21(3):177-80. 

Excluded - contains no or inadequate data 

Tsang MW, Mok M, Kam G, et al. Improvement in 

diabetes control with a monitoring system based on a 

hand-held, touch-screen electronic diary. J Telemed 

Telecare 2001 7(1):47-50. 

Excluded - does not address a key question 

Tsilimigaki A, Maraka S, Tsekoura T, et al. Eighteen 

months' experience with remote diagnosis, 

management and education in congenital heart 

disease. J Telemed Telecare 2001 7(4):239-43. 

Excluded - wrong population 

Tually P, Janssen J, Cowell S, et al. A preliminary 

assessment of Internet-based nuclear telecardiology to 

support the clinical management of cardiac disease in 

a remote community. J Telemed Telecare 2003 

9(Suppl 1):S69-71. 

Excluded - contains no or inadequate data 

Varri A, Koivuluoma M and Morvan C. A computerassisted visual sleep scoring program. Studies in 

Health Technology & Informatics 2000 78:285-97. 

Excluded - does not address a key question 

Wakefield BJ, Buresh KA, Flanagan JR, et al. 

Interactive video specialty consultations in long-term 

care. J Am Geriatr Soc 2004 May; 52(5):789-93. 

Excluded - no comparison group 

Wakefield BJ, Holman JE, Ray A, et al. Nurse and 

patient communication via low- and high-bandwidth 

home telecare systems. J Telemed Telecare 2004 

10(3):156-9. 

Excluded - does not address a key question 

Warden DL, Salazar AM, Martin EM, et al. A home 

program of rehabilitation for moderately severe 

traumatic brain injury patients. The DVHIP Study 

Group.[see comment]. J Head Trauma Rehabil 1092 

15(5):1092-102. 

Excluded - does not address a key question 

Watson J, Gasser L, Blignault I, et al. Taking 

telehealth to the bush: lessons from north Queensland. 

J Telemed Telecare 2001 7(Suppl 2):20-3. 

Excluded - does not address a key question 

Whited JD. Teledermatology. Current status and 

future directions. Am J Clin Dermatol 2001 2(2):59-

64. 

Excluded - does not address a key question 

Whitlock WL, Brown A, Moore K, et al. Telemedicine 

improved diabetic management. Mil Med 2000 

165(8):579-84. 

Excluded - does not address a key question 

Whitten P and Rowe-Adjibogoun J. Success and 

failure in a Michigan telepsychiatry programme. J 

Telemed Telecare 2002 8(Suppl 3):S3:75-7. 

Excluded - does not address a key question 

Whitten PS. Teledermatology delivery modalities: real 

time versus store and forward. Aktuelle Probl 

Dermatol 2003 32:24-31. 

Excluded - contains no or inadequate data 

Wiborg A, Widder B and Telemedicine in Stroke in 

Swabia P. Teleneurology to improve stroke care in 

rural areas: The Telemedicine in Stroke in Swabia 

(TESS) Project.[see comment]. Stroke 2003 Dec; 

34(12):2951-6. 

Excluded - contains no or inadequate data 

Wilson L, Onslow M and Lincoln M. Telehealth 

adaptation of the Lidcombe Program of Early 

Stuttering Intervention: five case studies. Am J Speech 

Lang Pathol 2004 Feb; 13(1):81-93. 

Excluded - wrong population 

Winters JM and Wang Y. Wearable sensors and 

telerehabilitation.[see comment]. IEEE Eng Med Biol 

Mag 2003 May-Jun; 22(3):56-65. 

Excluded - does not address a key question 

Wojcicki JM, Ladyzynski P, Krzymien J, et al. What 

we can really expect from telemedicine in intensive 

diabetes treatment: results from 3-year study on type 1 

pregnant diabetic women. Diabetes Technol Ther 

2001 Winter; 3(4):581-9. 

Excluded - wrong population 

Wootton R, Bloomer SE, Corbett R, et al. Multicentre 

randomised control trial comparing real time 

teledermatology with conventional outpatient 
D-21

dermatological care: societal cost-benefit analysis.[see 

comment]. Bmj 1252 320(7244):1252-6. 

Excluded - does not address a key question 

Wootton R, McKelvey A, McNicholl B, et al. Transfer 

of telemedical support to Cornwall from a national 

telemedicine network during a solar eclipse. J 

Telemed Telecare 2000 6(1) 

Excluded - does not address a key question 

Yogesan K, Cuypers M, Barry CJ, et al. Teleophthalmology screening for retinal and anterior 

segment diseases. J Telemed Telecare 2000 6(1) 

Excluded - included in previous report 

Young NL, Barden W, Lefort S, et al. Telehomecare: 

a comparison of three Canadian models. Telemed J E 

Health 2004 Spring; 10(1):45-52. 

Excluded - contains no or inadequate data 

Young TL and Ireson C. Effectiveness of school-based 

telehealth care in urban and rural elementary schools. 

Pediatrics 2003 Nov; 112(5):1088-94. 

Excluded - wrong population 

Zabalgoitia M and Ismaeil M. Diagnostic and 

prognostic use of stress echo in acute coronary 

syndromes including emergency department imaging. 

Echocardiography 2000 17(5):479-93. 

Excluded - does not address a key question 

Zaylor C, Nelson EL and Cook DJ. Clinical outcomes 

in a prison telepsychiatry clinic. J Telemed Telecare 

2001 7(Suppl 1):47-9. 

Excluded - wrong population 

Zenk BM, Bratton RL, Flipse TR, et al. Accuracy of 

detecting irregular cardiac rhythms via telemedicine. J 

Telemed Telecare 2004 10(1):55-8. 

Excluded - no comparison group 

Zhang R, Yamauchi K, Nonogawa M, et al. A 

telemedicine system for collaborative work on 

radiographic coronary video-images. J Telemed 

Telecare 2004 10(3):152-5. 

Excluded – contains no or inadequate data 
E-1

Appendix E: Peer Reviewers

Individuals 

Reviewer Affiliation 

Jeanette C. Hartshorn, PhD, RN, 

FAAN 

UTMB Telehealth Center 

University of Texas 

Galveston, TX 

Michael A. Hillman, MD, MBA Marshfield Clinic 

Marshfield, WI 

Penny Jennett, PhD Health Telematics Unit 

University of Calgary 

Calgary AB 

Bonnie J. Wakefield, PhD, RN Center for Research in the Implementation of 

Innovative Strategies in Practice (CRISP) 

VA Medical Center 

Iowa City, IA 

Organizations 

Organization/Agency Reviewer Affiliation 

American Academy of 

Dermatology 

Hon Pak, MD Department of Dermatology 

Brooke Army Medical Center 

Fort Sam Houston, TX 

American Telemedicine 

Association 

Nina Antoniotti, 

PhD, MBA, RN 

Marshfield Clinic Telehealth Network 

Marshfield, WI 

Association of 

Telehealth Service 

Providers 

Josie Henderson Telemedicine Research Center 

Portland, OR 

National Association for 

Home Care & Hospice 

Theresa Forster Vice President for Research 

NAHC 
E-2

Federal Agencies 

Agency for Healthcare 

Research and Quality 

J. Michael 

Fitzmaurice, 

Ph.D., FACMI 

Senior Science Advisor for Information 

Technology 

540 Gaither Road, Suite 3026 

Rockville, Maryland 

Agency for Healthcare 

Research and Quality 

Martin 

Erlichman, MS 

Task Order Officer 

540 Gaither Road 

Rockville, MD 

Centers for Medicare & 

Medicaid Services 

Shamiram R. 

Feinglass, MD, 

MPH 

Medical Officer 

Medicare Coverage & Analysis Group 

7500 Security Boulevard 

Mailstop C1-09-06 

Baltimore, MD 

Indian Health Service Mark Carroll, 

MD 

Flagstaff, AZ 

U.S. Department of 

Health and Human 

Services 

Dena Puskin, 

ScD 

Office for the Advancement of Telehealth 

Rockville, MD