Special issue on evaluation of telehealth and e-health systems and processes

This special issue is a tribute to the growth and rapid development of technology, laws1 and clinical practices in the telehealth domain. Telehealth, which encompasses telemedicine, is defined as the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. The main rational for the development and use of telehealth has always been to reduce organizational and geographical barriers to health services and to enhance access while achieving cost-containment goals. In 1996, the Institute of Medicine released its report ‘Telemedicine: A Guide to Assessing Telecommunications for Health Care’ (Institute of Medicine (US) Committee on Evaluating Clinical Applications of Telemedicine, 1996) stating at the time that ‘adoption of telemedicine would depend on complex, broadly distributed technical and human infrastructure that is only partly in place and is being profoundly affected by rapid changes in health care, information, and communications system’. This special issue reflects to some extent on the progress made since that time.

With the continuous evolution of telehealth, this field is now at the point where technologies and clinical advancements have reached a stable growth, facilitating the provision of telehealth. What was once constrained by technology and costs is now more accessible and easier to use and implement. A quick look back at the last 10 years shows vast improvements in performance and costs of video conferencing, one of the essential technologies underlying many telehealth applications, clearly driving the increased use by the general public and in health-care settings.

In addition there is also a better understanding of the clinical benefits and equivalence of care between telehealth and traditional care in many clinical domains, for example see Lasierra et al (2012), and Von Wangenheim et al (2012). In the field of telerehabililitation, results from a randomized clinical trial comparing in-person physical therapy to in-home telerehabilitation showed similar outcomes for patients at a cost reduced by 18% (Moffet et al, 2015; Tousignant et al, 2015). Fortney et al (2013) clearly demonstrated the advantages that the telehealth approach has over practice-based collaborative care in the domain of mental health.

Moving beyond the clinical effectiveness of telehealth and into the realm of its cost-effectiveness has remained challenging. While economic evidence on the use of telehealth has improved in the last 20 years (Mistry, 2012), published studies have pointed to the complexities of evaluating telehealth practices from this perspective. For example, recent results from the Diabetes Care Project in Australia, a pragmatic randomized control trial on telehealth and e-health on diabetic patients, showed an improvement in blood glucose levels and other clinical indicators in the experimental arm of the study, though the funding model used to facilitate adoption of the approach was not cost-effective and was unlikely to be scaled up nationally (Australian Department of Health, 2015).

With the growing acceptance and application of telehealth, there is a need for better understanding of the process behind telemedicine practices, application of modern modeling and evaluation techniques in order to fully understand and utilize this new approach. There is ample evidence that process improvement is a necessity in traditional practices of medicine especially with the continuous pressure on reducing cost and increasing quality of care (Pastore et al, 2013). In addition to evaluation of telehealth processes for clinical performance, there is a need to assess the business and financial aspects of such practices, especially compared with traditional face-to-face medical practices (Sinsky & Dugdale, 2013). Such pressure for continuous improvement requires the ability to evaluate telehealth processes – which is the theme of this special issue.

This special issue contains four papers exploring four important aspects of telehealth processes: simulation and cognitive training, innovations as impetus for change and social innovation, business models and cost benefit analysis.

The first paper by Shtub describes a simulator that helps train physicians to look at various clinical pieces of information and infer the status of the patient. This simulator, which is based on the emergency medicine clinical area, allows a physician being trained to view a patient’s history, his related images, audio and video, while the training physician can change the vitals displayed, present questions to the trainee and use similar functions. Such a simulator can in effect train physicians to diagnose and treat patients using telehealth technology.

The second article by Waas et al discusses the effects of innovation of telemedicine services. As the needs for telehealth continue to grow there is an emphasis on innovation as a driver of change, necessary to accommodate these needs. Having innovation at the forefront of telemedicine is viewed in this special issue looking not only at technological and clinical innovation but also considering social innovation and evaluation of information and communications technology.

Telehealth innovations are not only technological, but more importantly they involve new business models and health-care practices. Existing and evolving business models are important to the success of e-health implementations. This aspect is discussed in Acheampong’s article that provides an in-depth review of the literature related to business models in telemedicine.

Moreover, new services of telehealth are emerging very quickly requiring a fresh look at the business fundamentals (The New York Times, 2015). This rapid evolution of services and practices requires analysis of the cost-benefit aspects of e-health services as discussed in this issue. The fourth article by Myreteg presents an approach toward assessing the value of telehealth services and the cost-benefit as perceived by practitioners.

The editors of this special issue would like to thank all of the contributing authors and reviewers for their contribution and support of this important topic. These papers discuss some of the most important issues in the constantly evolving telehealth world including business models, innovation, training using simulation and assessing the value of this innovative approach for practical medicine.

Notes

1 Laws regarding telehealth vary among countries and states.