Telemedicine and e-Health

The use of e-health interventions to promote physical activity (PA) among older adults has significantly increased in recent years. This review aims to comprehensively summarize the various e-health modalities and strategies used to encourage PA in aging adults.

A systematic search of Medline, Embase, CINAHL, AMED, and PubMed databases was conducted to identify studies on e-health interventions targeting PA promotion in individuals aged 50 and older, published between 2012 and 2023. Information pertaining to study characteristics and e-health intervention specificities was extracted using a standardized data collection form. A narrative synthesis approach was employed to synthesize the data collected from the included studies.

Of 4,915 studies initially retrieved, 81 met the eligibility criteria. The findings reveal a diverse array of methods and interaction modes utilized to stimulate PA in aging adults, regardless of their medical conditions. Asynchronous methods such as web-based programs, mobile apps, and activity monitors were used in 71.6% of the studies and were most frequently employed for initiating behavior change components. Synchronous interaction modes mainly included videoconferencing and were predominantly featured in studies where real-time supervision and demonstration of exercises were integral to PA programs. There was a lack of information to guide the selection of the most effective e-health intervention format for motivating older adults to engage in regular exercise.

This review underscores the versatility of e-health interventions, showcasing a wide spectrum of methods and interaction modalities. Future studies should compare these different modalities and methods while also identifying their barriers and facilitators. This will help in selecting the most suitable interventions for older adults.

Despite positive perceptions of telemedicine, there’s a recognized need for stronger evidence on its safety and effectiveness. This study aims to evaluate telemedicine’s current status in diagnosing and treating peripheral vestibular symptoms.

Systematic searches across multiple databases assessed methodological quality using Physiotherapy Evidence Database scale and Revised Cochrane Risk of Bias tool for randomized trials 2.0.

Findings reveal significant improvements in vertigo-related disability with virtual vestibular rehabilitation (mean difference [MD] = −12.6; 95% confidence interval [CI] = −23.61, −1.59; p < 0.01; I ² = 76%) albeit with high heterogeneity. However, pooled analysis on vertigo severity across three studies did not show a significant effect (MD = −0.41; 95% CI = −0.64, −0.17; p < 0.78; I ² = 0%).

Evidence suggests telemedicine holds promise in diagnosing and managing peripheral vestibular disorders, potentially alleviating symptoms and improving disability. Nonetheless, caution is warranted due to review limitations, emphasizing the need for further research to optimize telemedicine’s benefits for patients experiencing vestibular symptoms.

Infertility and assisted reproduction treatment (ART) are frequently accompanied by the experience of emotional disorders. Psychological interventions are available for infertile populations, but the barriers of current face-to-face models of care difficult their dissemination. This systematic review (PROSPERO: CRD4202340179) aims to summarize how technologies are used in telemedicine psychological programs to manage emotional disorders in women undergoing fertility treatments.

Searches were conducted in December 2023 in six different databases. Two independent researchers conducted the searches, extracted the information, and assessed the quality of the studies (NHLBI tool).

Nineteen studies including 2,520 participants met eligibility criteria. Interventions were provided mostly to women who were undergoing in vitro fertilization/intracytoplasmic sperm injection (n = 11). Emotional disorders most frequently addressed were anxiety and depression (n = 11). The majority of the psychological programs were based on cognitive-behavioral therapy (n = 6), emotional writing (n = 3), acceptance and commitment therapy (n = 3), or positive reappraisal (n = 3). Many interventions were based on the use of internet (n = 5), diaries (n = 3), self-administered manuals (n = 2), short message service (n = 1), or face-to-face sessions (n = 5) supported by the inclusion of phone calls, emails, or audios. There is a lack of preventive interventions (n = 1).

To the best of our knowledge, this is the first systematic review that explores the use of all kinds of technologies to provide psychological interventions to manage emotional disorders during ART. Results derived from this work may guide the development of future telemedicine services to provide psychological interventions.

Telemedicine use increased substantially with the COVID-19 pandemic. Understanding of the impact of telemedicine modality (video vs. phone) on post-telemedicine acute care for higher risk conditions is limited.

We conducted a retrospective study of telemedicine visits, comparing video with telephone, for selected diagnoses with potentially higher illness acuity, evaluating post-telemedicine emergency department (ED) and hospitalization rates. In a large, multicenter cohort of adult patient-initiated primary care telemedicine visits from March 1, 2020, to July 31, 2021, we evaluated 7-day ED and hospitalization rates for higher acuity diagnostic categories (cardiac, gastrointestinal, and respiratory) by telemedicine modality, provider familiarity, and patient sociodemographic and clinical characteristics.

Among 431,705 telemedicine encounters, 128,129 (29.7%) were video visits and 303,576 (70.3%) were telephone visits. Adjusting for patient and appointment factors, telephone encounters for cardiac conditions were associated with significantly higher 7-day ED visit rates than video encounters (5.5% vs. 4.9%, respectively) but similar hospitalization rates (0.7% vs. 0.8%, respectively); for gastrointestinal conditions, post-telemedicine adjusted ED and hospitalization rates were comparable between telemedicine modalities (4.0% for ED and 1.2% vs. 1.3% for hospitalization, respectively); among respiratory conditions, video encounters were associated with higher ED and hospitalization rates than telephone encounters (ED: 5.9% after video vs. 5.2% after phone; hospitalization: 1.9% after video vs. 1.5% after phone). Telemedicine encounters with patients’ own primary care provider (PCP) were associated with lower adjusted rates of ED use across all conditions and modalities.

Short-term ED and hospitalization rates following primary care video or telephone visits for selected acute, high-risk conditions varied by condition and PCP familiarity. Nuanced use of video visits may confer benefits triaging to downstream acute care.

Teledermoscopy (TDS) emerges as an efficient tool for diagnosing skin lesions. In Sweden, double reading is the standard of care, but risk factors for misdiagnosis or mismanagement using single reader evaluations (SRE) are not well-studied. This study aimed to assess the accuracy of SRE compared with the gold standard in TDS.

This retrospective cohort study involved 1,997 TDS referrals sent from general practitioners to dermatologists in Stockholm, Sweden, selected based on dermoscopic diagnoses. All referrals underwent double reader evaluations (DRE). Each case was reassessed by a single external assessor, blinded to the DRE result. Based on predefined rules, a gold standard for the most correct diagnosis was established. Diagnostic accuracy and risk factors for misdiagnosis were evaluated. The trial was registered on ClinicalTrials.gov (ID NCT05033678).

Primary diagnosis by SRE agreed with the gold standard on benign-malignant classification in 84% of cases. Discordance was linked to lower diagnostic confidence and more frequent recommendations for further intervention. SRE achieved a benign-malignant sensitivity and specificity of 84% (95% confidence interval: 81–87% and 82–86%, respectively). The risk of overdiagnosis increased 96 times when assessors reported being “very unconfident.” Out of a total of 311 melanomas, melanoma in situ, lentigo maligna, and severely dysplastic nevi, 62 were not recognized in the SRE primary diagnosis. However, 50 of these misdiagnosed lesions were still recommended for accurate management.

The confidence level of TDS assessors heavily influences diagnostic accuracy. Therefore, when diagnostic confidence is perceived as moderate or low, additional interventions should be considered.

Increasing carbon dioxide (CO₂) in the atmosphere contributes to Earth’s warming, which has negative impacts on human health. The health care system is a major contributor to CO₂ emissions. Telehealth has the capacity to reduce health-care-related emissions by eliminating patient travel to in-person appointments.

Data were obtained from Nebraska Medicine's (NM) electronic medical record. Parameters included patient zip code, provider location, calendar year of visit, and provider specialty. Euclidean distance from centroid zip code to clinic location was calculated. Environmental Protection Agency estimates were used to convert mileage to CO₂ saved.

During the period January 1, 2019, to January 31, 2022, the NM health care system completed 214,241 telemedicine visits for patients whose home zip code is within Nebraska, resulting in greater than 2,600 metric tons of CO₂ avoided. Telehealth appointments increased by more than 22,000% from 2019 to 2020. An average of 12.38 kg of CO₂ was avoided with each telehealth visit. Medical specialties that avoided the most CO₂ included family medicine, endocrinology, and infectious disease.

This study demonstrates the capability of the NM health care system to rapidly adjust to an emergency pandemic by drastically increasing the use of telehealth, which also avoided thousands of tons of transportation-associated CO₂ emissions. Telehealth appointments increased during the height of the pandemic by more than 22,000%. Telehealth is an effective CO₂ emission-reducing strategy and a worthy avenue to further explore reduced health-care-related emissions.

Pediatric dermatology access is limited. Pediatric teledermatology (TD) opens the opportunity to explore diverse dermatological pathology promptly. Different TD modalities and providers may influence the consulting population. This study compares a synchronous TD from a private provider with the asynchronous TD of the public sector in Chile’s health care system.

A descriptive and inferential analysis of 168 synchronous and 239 asynchronous pediatric teleconsultations, responded from January 2023 to August 2023.

Pediatric teleconsultations accounted for nearly one-fifth of all consultations in both models. The synchronous group was significantly older (p = 0.0065; 10.18 years ± 5.43 [0–18 years]) than the asynchronous group (8.65 years ± 5.74 [0–18 years]). June marked the highest and lowest teleconsultation volumes in synchronous and asynchronous platforms, respectively. The most frequent diagnostic group in both modalities was the noninfectious inflammatory pathology. Significant differences were noted within this group (p < 0.0001), with acne and dermatitis being predominant in the synchronous model. Significant differences also emerged within the infectious inflammatory group (p = 0.002), with bacterial and fungal infections being more common in the synchronous modality, whereas chronic viral infections predominated in the asynchronous group.

Pediatric TD is an emerging tool that optimizes access, manages the demand, and reduces waiting times. Seasonal variations may influence caregiver preferences for a specific attention model. The consulting population using synchronous and asynchronous modalities differs significantly in age and diagnostic distributions. Understanding these differences is crucial for effectively addressing specific practice gaps in each attention model.

Teleradiology is one of the earliest successful telemedicine applications that has fueled the digital transformation of radiology services. It started as a point-to-point service for a single department. Now, there is a growing need for an enterprise-wide radiology platform involving multiple radiology departments with many different information technology infrastructures as radiology services are consolidating and reorganizing. The article aims to review the evolution of the country-wide virtual radiology platform supporting many different radiology departments throughout Korea and discusses technical and management lessons learned in the process and identify new requirements.

Research materials are based on reviews of publications on teleradiology, telemedicine, picture archiving and communication systems (PACS), digital transformation, and internal engineering and management documents of Hesel Clinics, the developer of the system, over the past 20 years. We also reviewed the aspects of health care systems in Korea that played an important role in digital transformation and teleradiology.

The Korean enterprise imaging platform is fully operational and growing. Certainly, the Digital Imaging and Communications in Medicine (DICOM) standard in radiology is foundational technology enabling teleradiology and PACS, but it is insufficient for enterprise platforms.

For an enterprise imaging platform, one must integrate information from multiple subsystems such as PACS, radiology information systems, and electronic health records from many heterogeneous radiology departments with varying workflows. Data standards need to extend beyond DICOM, and standard tools for system integration are needed.

: Interprofessional electronic consultations (eConsults) can reduce health care utilization and improve access to specialty care. However, health care utilization and access impacts of eConsults for headache disorders remain incompletely characterized.

: We conducted a retrospective, 1:3-matched cohort study comparing patients referred for in-person headache evaluations to patients who had a headache-related eConsult. The cohorts were propensity score-matched by age, sex, race, preferred language, provider specialty, insurance status, and medical comorbidities. Our primary outcome was the presence of one or more headache-related ambulatory encounters in the 12 months following the index referral date. We used univariable and conditional logistic regression models to ascertain the associations between referral type and outcome.

: We identified 74 and 222 patients with eConsult and in-person referrals, respectively. Over the follow-up period, the proportion of patients with the primary outcome was significantly greater in the eConsult cohort than the in-person cohort (46.0% vs. 43.2%, p < 0.0001). A greater proportion of the in-person cohort had one or more ambulatory headache encounters in the 12 months preceding their referral than the eConsult cohort (10.8% vs. 5.4%, p < 0.0001). In the adjusted analysis, eConsult usage was not associated with significantly increased odds of the primary outcome (adjusted odds ratio [aOR] 1.1, 95% confidence interval [CI] 0.6–2.0, p = 0.71), although patients with one or more ambulatory neurology encounters in the preceding 12 months had significantly increased odds of the primary outcome (aOR 3.1, 95% CI 1.2–7.9, p = 0.015).

: Compared to in-person referrals, eConsult use for headache was not associated with significantly increased odds of having subsequent ambulatory headache-related encounters.

Telemedicine has emerged as a promising solution to address the challenges of providing continuous care to breast cancer patients, particularly in remote areas. This study aims to assess the acceptability of using telemedicine for breast cancer follow-up.

A cross-sectional study utilizing a self-administered survey was conducted from January to March 2024 among 450 breast cancer patients at the Universiti Malaya Medical Center, Malaysia. Partial least-squares structural equation modeling was used to identify factors such as demographics, patients’ characteristics, experience with telemedicine, attitudes, and concern of telemedicine use influencing willingness to use telemedicine for breast cancer follow-up.

Of the total 450 complete responses received, nearly half (49.3%) reported being somewhat likely to seek telemedicine for breast cancer follow-up, while only 11.1% reported being very likely. Comfort with telemedicine emerged as the strongest predictor of willingness to use it (β = 0.757, p < 0.001). A higher level of concern significantly negatively impacted willingness (β = −0.138, p < 0.001). However, attitudes toward telemedicine (β = 0.059, p = 0.144) were not significantly associated with its use. Among demographic factors, only age (β = 0.074, p = 0.018) was significantly positively associated with the willingness to use telemedicine, while education levels were found to have a significant inverse association (β = −0.076, p = 0.034).

Improving comfort with telemedicine and addressing various concerns about its use for breast cancer follow-up through educational programs and support services are essential. Tailoring communication and support for different age groups and education levels can also enhance acceptance and utilization.

In order to assess patient experiences of telemedicine, researchers and administrators use the net promoter score (NPS), based on a likelihood to recommend (LTR) question. However, there is reason to doubt validity of this metric for this purpose. We assessed the degree to which the LTR question reflects actual patient preferences about telemedicine.

Using data from a patient experience survey collected in Spring 2020, we compared LTR responses to open comments. Through content analysis, we transformed comments into categorical variables and used those variables in a multiple logistic regression model to predict LTR responses. We also thematically analyzed comments to further elucidate our results.

Only about half the comments mentioned telemedicine at all. Around 6% of comments were wholly incongruent with LTR responses. In many comments, ideas about telemedicine were semantically entangled with ideas about providers. Our logistic regression found strong associations between sentiments expressed in comments and LTR responses. However, comments about telemedicine were relatively poor predictors for LTR compared to comments about the provider.

NPS, which is included on many patient experience surveys used by health systems across the United States, has limitations for use as a measure of the acceptability of telemedicine for patients. Patients have more than telemedicine in mind when responding to the LTR question, and ratings conflate attitudes about providers, office policies, and staff with the telemedicine modality. More direct measures are necessary for meaningful research on the acceptability and usability of telemedicine for patients.

The COVID-19 pandemic exposed significant frailties of the U.S. healthcare system, especially inequities facing rural areas during surges when critical access and small community hospitals could not transfer patients to referral centers that were already overcapacity. Many clinicians suffered moral injury from managing these patients beyond their scope of practice or from the need to triage care.

The National Emergency Tele-Critical Care Network (NETCCN) sought to provide a lifeline of free, ad hoc consultation to clinicians who needed help – a critical care “911” system – by using mobile devices and easy-to-use applications designed to help clinicians rapidly communicate with experts.

NETCCN provided 1,863 days of coverage to 60 hospitals in 17 states and U.S. territories at a fraction of the cost of boots-on-the ground emergency support.

We review our experience delivering this support and provide recommendations to guide future development and integration of telemedicine programs into the National Disaster Medical System.