Abstract
The number of peer-reviewed publications in the telemedicine field has risen over the last ten years. As the number of publications increases, it becomes difficult to obtain an understanding of the field as a whole. To date, systematic reviews and guidelines have concentrated on specific telemedicine applications. There is no overview of the current situation regarding systematic reviews of telemedicine. Such an overview could provide answers to questions such as:
Which applications of telemedicine have been the subject of reviews? What are the needs for conducting systematic reviews in the future?
We have therefore reviewed the systematic reviews in telemedicine.
Methods
A study was conducted of all reviews that had been published up to the end of 2009. The following databases were searched: Medline, EMBASE, CINAHL, PsycInfo and Cochrane. The following keywords were used in the search: Telemedicine OR telehealth OR telecare OR teleconsultation OR telepsychiatry OR teleophthalmology OR teleneurology OR telepathology OR teleradiology OR telehome care OR telecardiology OR telepaediatrics OR telepediatrics OR teletrauma OR teleemergency OR teleotolaryngology
The database searches included all types of review papers, including meta-analyses. Papers were included if they were reviews of the telemedicine field generally. The definition of telemedicine was the use of any type of telecommunication technology, including the short messaging service (SMS), telephone, the Internet or videoconferencing, to provide or receive health advice or a medical consultation. Some papers consisted of a brief paper extracted from previous comprehensive reports. In this situation, only the summary paper was entered into the present review.
All articles retrieved from the databases were imported into a reference manager (Endnote XI) and duplicates were discarded. All titles and keywords were read and non-relevant papers were excluded. Papers were discarded unless they reported they had done their review systematically somewhere in the paper. After arriving at a final list of papers that met all the inclusion criteria, the papers were classified according to the subject of the review.
Classification
Papers were categorised based on the focus of their applications or specialty. Papers with no specific application, examining general aspects of telemedicine such as feasibility, economics or satisfaction with a service, were grouped as ‘General’. All papers that had reviewed the use of telemedicine for the delivery of health and medical services to homes were classified as ‘home telecare’, regardless of their specialty.
Results
The search identified 55 systematic reviews. 1–55 The details of their selection are summarised in Table 1. The categories in which most reviews had been conducted were home telecare (16) and general (16), which together accounted for over half of the published papers which were selected for the present study (see Table 2).
Search results
Classification of the 55 systematic reviews
Discussion
The present study shows that there have been 16 systematic reviews focused on general aspects of telemedicine, such as feasibility, outcomes, economics and satisfaction. This seems reasonable, as telemedicine is still a comparatively young field and there are various questions that have not yet been answered. For example, the issue of whether telemedicine is economically viable has not yet been adequately addressed.
From the results shown in Table 2, it is evident that home telecare is an application of interest to systematic reviewers. The increase in the elderly population might be one explanation why home telecare has received more attention in comparison with other applications.
There have been seven systematic reviews of telecardiology and telepsychiatry. These reviews have explored these topics very broadly and have provided a very comprehensive summary of work.
There are two main criticisms of the available systematic reviews in the telemedicine domain. First, while there has been significant progress in some applications of telemedicine over the last decade, many do not have comprehensive reviews in peer-reviewed journals. Telepathology, teleradiology, tele-ophthalmology and tele-ENT are examples of such applications. Second, many applications do not have up-to-date reviews. For instance, the last teledermatology review was carried out in 2006. The overall number of systematic reviews in the field of telemedicine indicates that it remains underdeveloped.
Although there have been surprisingly few systematic reviews in fields such as teleradiology and telepathology, it must be acknowledged that there have been many non-systematic reviews of these topics, including those published in books and book chapters. The results of the present study emphasise that systematic reviews, which are an important type of publication in any domain of science, have not been conducted for many aspects of telemedicine so far.