THE IMPACT ON TELEMEDICINE ON HEALHCARE DELIVERY

Euodia Anaeme
Public health
Joint professional training and support
26-06-2025

ABSTRACT
Telemedicine has revolutionized healthcare delivery by increasing accessibility improving

patient engagement and enhancing chronic disease management .this abstract explores the

impact of telemedicine on healthcare delivery ,highlighting its benefits ,challenges and future

directions .by leveraging technology ,telemedicine has expanded healthcare service to remote

and underserved areas reduced cost and improve health outcomes .however challenges such

as technological barriers, privacy concerns and regulatory issues need to be addressed.as

telemedicine continues to evolve ,it is essential to understand its impact on healthcare

delivery and work towards creating a more efficient and patient-centered healthcare system.

The review also highlight the role of telemedicine in addressing healthcare disparities

particularly in rural and remote areas where access to traditional healthcare services is

limited.

Key point

.increased accessibility and patient engagement

. improve chronic diseases management and health outcomes

. reduce cost and expanded healthcare services

TABLE OF CONTENT

-Introduction and benefit

-Challenges

-Importance

-Impact on telemedicine
-Strength and limitation

-Direction for use of telemedicine

-Methodology

-Conclution

-Reference

INTRODUCTION
Telemedicine, defined as the remote delivery of healthcare services using

telecommunications technology, has revolutionized the way medical care is provided. It

encompasses a wide range of practices and technologies, including virtual consultations,

remote patient monitoring, and mobile health applications.[1] By enabling healthcare

professionals to evaluate, diagnose, and treat patients without the need for an in-person visit,

telemedicine offers a flexible, efficient, and accessible alternative to traditional healthcare

delivery.

The concept of telemedicine dates to the early 20th century when radio was used to provide

medical advice to ships at sea. Over the decades, advancements in technology, such as the

telephone, and later, the internet, have significantly expanded the capabilities and reach of

telemedicine. In the 1960s, NASA utilized telemedicine to monitor the health of astronauts in

space, marking a pivotal moment in its development.[2] The advent of video conferencing

technology in the late 20th century further propelled telemedicine, making real-time, face-to-

face consultations possible.[2] Today, telemedicine plays a crucial role in the healthcare

landscape, driven by the need for efficient, cost-effective, and patient-centered care. It

addresses critical issues such as the shortage of healthcare professionals, especially in rural

and underserved areas, and the need for timely medical intervention. Telemedicine has
become particularly important during the COVID-19 pandemic, providing a safe alternative

to in-person visits, and ensuring continuity of care while minimizing the risk of virus

transmission.[3]

This article aims to explore the emerging trends in telemedicine, examining the latest

technological advancements, regulatory and ethical considerations, and the impact of

telemedicine on different patient populations. By providing a comprehensive overview, this

article seeks to inform healthcare providers, policymakers, and researchers about the current

state and prospects of virtual healthcare, highlighting its potential to transform the delivery of

medical services globally.

Technological Advances in Telemedicine Technological advances in telemedicine,

including improvements in telecommunication and connectivity, the growth of mHealth

applications, the development of wearable technology, and the integration of AI and machine

learning, have significantly transformed the healthcare landscape.[4] These innovations have

enhanced the accessibility, quality, and efficiency of healthcare services, enabling more

personalized and proactive patient care. As telemedicine continues to evolve, it holds the

promise of further revolutionizing the delivery of healthcare, making it more patient-centered

and datadriven.

Telecommunication and Connectivity Improvements

Role of 5G and Broadband in Enhancing Telemedicine Services: The advent of 5G and

advancements in broadband technology have significantly enhanced telemedicine services.

5G technology offers faster internet speeds, lower latency, and more reliable connections

compared to its predecessors. This is crucial for telemedicine, as it ensures high-quality

video consultations without lag or interruption. With 5G, healthcare providers can deliver

real-time, interactive medical services, including high-definition video consultations, remote

surgery, and rapid data transmission.[5]

Impact of Improved Connectivity on Rural and Underserved Areas

Improved connectivity has profound implications for rural and underserved areas, where

access to healthcare services is often limited. Enhanced broadband infrastructure enables

these regions to access telemedicine services, bridging the gap between patients and

healthcare providers. This has led to increased healthcare accessibility, allowing patients to

receive timely medical advice, consultations, and follow-up care without the need to travel

long distances. As a result, telemedicine helps mitigate healthcare disparities, ensuring more

equitable access to medical services.

Mobile Health (mHealth) Applications

Growth of Health Apps and Their Role in Patient Monitoring and Management: The

proliferation of mobile health (mHealth) applications has transformed patient monitoring and

management. Health apps are designed to track various health metrics, such as heart rate,

blood pressure, glucose levels, and physical activity. These apps provide patients with the

tools to monitor their health in realtime, promote adherence to treatment plans, and offer

personalized health insights.[7] The convenience and accessibility of mHealth apps empower

patients to take a proactive role in their health management, improving overall health

outcomes.

Integration of mHealth with Electronic Health Records (EHRs)

The integration of mHealth applications with electronic health records (EHRs) has further

enhanced their utility. By linking health apps with plays a crucial role in predictive analytics

and decision support systems in telemedicine. ML models analyze historical patient data to

predict future health events, such as disease progression or the likelihood of readmission.

These predictive insights enable healthcare providers to implement preventive measures,

improving patient outcomes and reducing healthcare costs. Decision support systems

powered by ML assist clinicians in making evidence-based decisions by providing real-time

recommendations based on the latest medical research and patient data. This enhances the

quality of care and supports clinical workflows.

Mental Health Telemedicine: Telemedicine has significantly expanded access to mental

health services through telepsychiatry and telepsychology. These services include virtual

consultations with psychiatrists, psychologists, and counselors, making mental health care

more accessible to people in remote or underserved areas. Telehealth platforms enable

continuous care for patients with mental health disorders, providing a convenient way to

manage therapy sessions, medication reviews, and follow-up appointments. The anonymity

and comfort of receiving care from home can also reduce the stigma associated with seeking

mental health

treatment.[29]

Impact of COVID-19 on Telemedicine: The COVID-19 pandemic has catalyzed a

significant transformation in telemedicine, driving rapid adoption and revealing its critical

role in modern healthcare. The experiences and innovations during this period have provided

valuable lessons, shaping the future direction of telehealth. As healthcare systems continue to

adapt and integrate telemedicine, it will play an increasingly vital role in delivering

accessible, efficient, and patient-centered care. Acceleration of Telemedicine Adoption:

The COVID-19 pandemic has significantly accelerated the adoption of telemedicine,

transforming it from a supplementary service to a primary mode of healthcare delivery. As

social distancing measures and lockdowns restricted in-person visits, healthcare providers

rapidly pivoted to telehealth to maintain continuity of care. Regulatory bodies also responded

by temporarily relaxing guidelines and expanding reimbursement policies, facilitating wider

use of telemedicine.[31] This rapid shift demonstrated telemedicine's potential to provide safe,

efficient, and accessible healthcare, leading to its acceptance across various medical

specialties
Case Studies of Successful Telemedicine Implementations During COVID-19: One

notable example is the Cleveland Clinic, which expanded its telehealth services dramatically

during the pandemic. By integrating telemedicine into their care model, they conducted over

60,000 virtual visits in March 2020 alone, compared to 3,400 visits in the previous month.[32]

Similarly, the UK’s National Health Service (NHS) rolled out a comprehensive telehealth

strategy, providing remote consultations and triage services to reduce hospital visits and

manage patient care efficiently.[33] In India, Apollo Hospitals launched a telemedicine

platform that saw a 300% increase in usage, helping to manage the

overwhelming patient load during the crisis

Challenges Faced and Solutions Implemented: The rapid expansion of telemedicine

during the pandemic was not without challenges. Many healthcare providers faced technical

issues, including inadequate infrastructure and lack of training in telehealth technologies.

Patients, especially the elderly and those in rural areas, struggled with accessing and

navigating telehealth platforms. To address these challenges, healthcare systems

implemented various solutions. Investments were made to upgrade IT infrastructure, and

comprehensive training programs were developed for both providers and patients.

Additionally, userfriendly interfaces and support systems were established to assist patients

in using telehealth services effectively.[35]

Long-Term Changes in Telemedicine Practices Post-Pandemic: The pandemic has

brought lasting changes to telemedicine practices, with many temporary measures likely to

become permanent. Telehealth is expected to remain a key component of healthcare delivery,

complementing traditional inperson visits. Healthcare providers are increasingly recognizing

the benefits of a hybrid model, which combines virtual and physical consultations to

optimize patient care. Regulatory frameworks are being updated to support sustained

telehealth use, and ongoing advancements in technology will continue to enhance the

capabilities of telemedicine.[36] Furthermore, the integration of telehealth into routine care is

anticipated to improve patient engagement, expand access to specialty care, and enhance

overall healthcare efficiency.

Future Directions and Emerging Trends: The future of telemedicine lies in its integration

with traditional healthcare, addressing global health disparities, focusing on patient-centered

care, and embracing sustainability. These emerging trends promise to enhance the quality,

accessibility, and environmental impact of healthcare worldwide.

Integration of Telemedicine with Traditional Healthcare: The future of healthcare is

likely to see a seamless integration of telemedicine with traditional in-person care, creating

hybrid models that leverage the strengths of both. These models will enable patients to

receive routine and follow-up care virtually, reserving in-person visits for more complex

cases requiring physical examination or intervention. This approach not only enhances

accessibility and convenience but also optimizes resource allocation, reducing the strain on

healthcare facilities.[37]

Prospects for Seamless Integration: For seamless integration, healthcare systems will

invest in interoperable technologies that allow easy sharing of patient data across platforms.

Electronic Health Records (EHRs) will be pivotal, ensuring that telemedicine interactions are

thoroughly documented and accessible to all care providers involved in a patient’s treatment.

Training programs for healthcare professionals on using telemedicine tools effectively will

also be essential to this transition.[38]

Role of Telemedicine in Addressing Global Health Disparities: Telemedicine has the

potential to address global health disparities by providing remote access to medical expertise

and services in underserved regions. It can overcome geographical barriers, bringing

specialist care to areas with limited healthcare infrastructure. This is particularly valuable in

managing chronic diseases, maternal health, and infectious diseases in low-resource settings.
[38]
International Collaborations and Innovations: International collaborations can drive

innovations in telemedicine, sharing best practices and developing scalable solutions for
global health challenges. For example, global health organizations can partner with tech

companies to create affordable telehealth platforms, while international training programs

can enhance the skills of healthcare providers

worldwide.[39]

Enhancing Patient Engagement and Satisfaction: Telemedicine must focus on enhancing

patient engagement and satisfaction by providing userfriendly platforms and personalized

care. Features like real-time communication, easy access to medical records, and integrated

health tracking can make telehealth experiences more interactive and

satisfying for patients

Customizing Telemedicine Services to Meet Individual Patient Needs: Customization of

telemedicine services involves tailoring care plans to meet individual patient needs,

considering their medical history, preferences, and lifestyle. Personalized telehealth solutions

can include reminders for medication adherence, tailored exercise programs, and dietary

advice, contributing to better health outcomes

Remote Patient Monitoring Systems

Types of Remote Monitoring Devices and Their Applications: Remote patient monitoring

(RPM) systems utilize a variety of devices to track patients' health data outside traditional

clinical settings. Common devices include blood pressure monitors, glucose meters, pulse

oximeters, and wearable sensors for tracking heart rate and activity levels. These devices are

particularly useful for managing chronic conditions such as diabetes, hypertension, and heart

disease. By continuously collecting health data, RPM systems enable healthcare providers to

monitor patients' conditions in real-time, detect early signs of deterioration, and intervene

romptly.[15]

Impact on Patient Outcomes and Healthcare Costs: RPM systems have a positive impact

on patient outcomes and healthcare costs. By providing continuous monitoring, these systems

help reduce hospital readmissions and emergency room visits, leading to better health
outcomes for patients. Early detection of health issues allows for timely interventions,

preventing complications and enhancing the quality of care. Moreover, RPM systems reduce

healthcare costs by minimizing the need for in-person visits and hospitalizations. For

example, patients with heart failure who use RPM systems have shown significant reductions

in readmission rates, translating into cost savings for

healthcare systems.[16]

Tele-homecare

Innovations in Home-Based Healthcare Services: Tele-homecare represents an innovative

approach to delivering healthcare services directly to patients' homes. This model combines

teleconsultations and RPM to provide comprehensive care for patients with chronic illnesses,

disabilities, or post-operative needs. Innovations in tele-homecare include smart home

devices that monitor environmental factors, automated medication dispensers, and virtual

rehabilitation programs. These technologies enable patients to receive personalized care in

the comfort of their homes, improving their quality of life and promoting independence.[17]

Case Studies and Examples of Successful Telehomecare Programs: Several successful

telehomecare programs demonstrate the effectiveness of this approach. One notable example

is the Veterans Health Administration's (VHA) Home Telehealth program, which has

significantly reduced hospital admissions and emergency visits for veterans with chronic

conditions.[18] By utilizing RPM devices and regular teleconsultations, the VHA has

improved health outcomes and patient satisfaction. Another example is the University of

Southern California's Keck School of Medicine's tele-homecare program for heart failure

patients.[19] This program combines daily monitoring of vital signs with virtual consultations,

leading to a reduction in readmissions and improved management of heart failure symptoms.

Legal, Ethical, and Regulatory Considerations Regulatory Frameworks: The regulatory

landscape for telemedicine varies significantly across different regions. In the United States,

telemedicine is regulated at both federal and state levels. The Centers for Medicare &
Medicaid Services (CMS) provide guidelines for telehealth services, while state medical

boards oversee licensure and practice standards. In Europe, regulations differ by country,

with the European Union providing a framework to facilitate

Virtual Consultation and Remote Patient Monitoring Teleconsultations

Platforms and Tools for Virtual Consultations: Teleconsultations have become a

cornerstone of telemedicine, facilitated by various platforms and tools. These platforms

include video conferencing applications like Zoom, Skype, and dedicated telemedicine

solutions such as Teladoc, Amwell, and Doxy.me [13]. These tools offer secure,

HIPAAcompliant environments for healthcare providers to conduct virtual consultations with

patients. Features such as high-definition video, screen sharing, and integrated scheduling

systems make teleconsultations efficient and user-friendly for both providers and

patients.[13]

Benefits and Challenges of Teleconsultations for Various Medical Specialties:

Teleconsultations offer numerous benefits across various medical specialties. For primary

care, they provide a convenient way to address minor ailments, manage chronic conditions,

and conduct follow-ups. In specialties like psychiatry and dermatology, teleconsultations

enable providers to offer timely care without the need for physical exams. They also facilitate

access to specialist care for patients in remote areas [14]. However, teleconsultations present

challenges, including the inability to perform physical examinations, potential technological

barriers for patients, and concerns about data security. Additionally, some specialties, such as

surgery, require in-person assessments, limiting the scope of teleconsultations.

Recent Changes in Policy Due to the COVID-19 Pandemic: The COVID-19 pandemic has

led to significant policy changes to support the rapid adoption of telemedicine. In the U.S.,

CMS expanded telehealth coverage under Medicare, allowing more services to be provided

remotely.[22] Temporary waivers relaxed licensure requirements, enabling providers to offer

telemedicine across state lines. Many countries, including the U.K., Canada, and Australia,

introduced similar measures to enhance telehealth access during the pandemic.[20] These

changes have highlighted the potential of telemedicine, prompting discussions on making

some temporary measures permanent to sustain telehealth growth post-pandemic.

Ethical Issues: Maintaining patient confidentiality and data security is a critical ethical

concern in telemedicine. Telehealth services involve the transmission and storage of sensitive

patient information, necessitating robust security measures. Healthcare providers must use

secure, HIPAAcompliant platforms to protect patient data from unauthorized access and

breaches. Encryption, twofactor authentication, and regular security audits are essential

practices to safeguard patient information. Ensuring data security not only complies with

legal requirements but also builds patient trust in telemedicine services.[23]

Informed Consent and Telemedicine: Informed consent is another vital ethical issue in

telemedicine. Patients must be fully informed about the nature of telehealth services,

including the potential risks, benefits, and alternatives. Providers should explain how the

technology works, any limitations of remote care, and the measures taken to ensure data

security. Obtaining informed consent involves clear communication and documentation,

ensuring that patients understand and agree to the telemedicine process. This practice

respects patient autonomy and fosters a transparent provider-patient relationship.[24]

Reimbursement and Insurance: Reimbursement for telemedicine services has historically

been a significant barrier to its widespread adoption. Traditional insurance models often did

not cover telehealth services, limiting provider participation. However, recent developments

have addressed these challenges. In the U.S., Medicare and many private insurers expanded

coverage for telehealth, reimbursing a wider range of services at rates comparable to in-

person visits. Some states have enacted parity laws, mandating that insurers cover

telemedicine services.[25] Despite these advancements, inconsistencies in reimbursement

policies remain, requiring ongoing advocacy and policy reform.

Role of Insurance Companies in Promoting Telemedicine Adoption: Insurance

companies play a crucial role in promoting telemedicine adoption. By offering

comprehensive coverage for telehealth services, insurers can encourage both providers and

patients to utilize remote care. Some insurers have introduced specific telemedicine

programs, partnering with telehealth platforms to offer convenient and cost-effective care

options. Additionally, insurers can incentivize the use of telemedicine through reduced

copayments and innovative reimbursement models that emphasize value-based care. These

efforts contribute to the integration of telemedicine into mainstream healthcare, enhancing

access and efficiency.[26] Telemedicine in Special Populations

Pediatric Telemedicine: Telemedicine offers numerous applications and benefits for

pediatric care. It facilitates remote consultations for routine checkups, follow-ups, and

management of chronic conditions such as asthma and diabetes. Telemedicine is particularly

useful in providing immediate care for minor illnesses, reducing the need for parents to take

time off work or travel long distances. It also enables specialists to collaborate with primary

care providers to deliver comprehensive care. Telehealth can support early intervention

services, including speech and occupational therapy, ensuring children receive timely and

consistent

care.[27]

When implementing telehealth for children, several special considerations must be

addressed. Ensuring a child-friendly approach is crucial, which includes using engaging, age-

appropriate communication methods. Providers must be adept at interacting with both the

child and their parents or guardians, who play a critical role in managing the child’s health.

Privacy and confidentiality are particularly important, as children’s medical information

needs to be securely protected. Additionally, providers must be trained to recognize the

limitations of virtual examinations and know when to recommend inperson visits for accurate

diagnosis and treatment.

Geriatric Telemedicine: Telemedicine can significantly enhance the care of elderly patients

by providing convenient access to healthcare services, especially for those with mobility

issues or chronic conditions. It allows for regular monitoring of health conditions such as

hypertension, diabetes, and heart disease, which are prevalent in the elderly population.

Telemedicine can also facilitate medication management, ensuring that elderly patients

adhere to their prescribed regimens. Remote consultations can help detect early signs of

health deterioration, enabling timely interventions and reducing the risk of complications. [28]

Prospects for Seamless Integration: For seamless integration, healthcare systems will

invest in interoperable technologies that allow easy sharing of patient data across platforms.

Electronic Health Records (EHRs) will be pivotal, ensuring that telemedicine interactions are

thoroughly documented and accessible to all care providers involved in a patient’s treatment.

Training programs for healthcare professionals on using telemedicine tools effectively will

also be essential to this transition.[38]

Role of Telemedicine in Addressing Global Health Disparities: Telemedicine has the

potential to address global health disparities by providing remote access to medical expertise

and services in underserved regions. It can overcome geographical barriers, bringing

specialist care to areas with limited healthcare infrastructure. This is particularly valuable in

managing chronic diseases, maternal health, and infectious diseases in low-resource settings.
[38]
International Collaborations and Innovations: International collaborations can drive

innovations in telemedicine, sharing best practices and developing scalable solutions for

global health challenges. For example, global health organizations can partner with tech

companies to create affordable telehealth platforms, while international training programs

can enhance the skills of healthcare providers

worldwide.[39]

satisfying for patients.

CONCLUSION

Telemedicine represents a transformative force in modern healthcare, offering solutions to

challenges of access, efficiency, and sustainability. As telemedicine continues to evolve, its

integration with traditional care, its role in global health equity, and its focus on patient-

centeredness will shape the future of healthcare delivery. By embracing telemedicine's

potential and addressing its challenges, healthcare systems can strive towards providing

accessible, high-quality care to all patients, while also contributing to environmental

conservation and the advancement of healthcare practices worldwide

REFERENCES

1. Haleem A, Javaid M, Singh RP, Suman R. Telemedicine for healthcare: Capabilities,

features, barriers, and applications. Sens Int. 2021;2:100117. doi:

10.1016/j.sintl.2021.100117.

2. Nicogossian AE, Pober DF, Roy SA. Evolution of telemedicine in the space program and

earth applications. Telemed J E Health. 2001 Spring;7(1):1-15. doi:

10.1089/153056201300093813.

3. Tozour JN, Bandremer S, Patberg E, Zavala J, Akerman M, Chavez M, et al. Application

of telemedicine video visits in a maternal-fetal medicine practice at the epicenter of the

COVID-19 pandemic. Am J Obstet Gynecol MFM. 2021 Nov;3(6):100469. doi:

10.1016/j.ajogmf.2021.100469.

4. Stoumpos AI, Kitsios F, Talias MA. Digital Transformation in Healthcare: Technology

Acceptance and Its Applications. Int J Environ Res Public Health. 2023 Feb

15;20(4):3407. doi: 10.3390/ijerph20043407.

5. Georgiou KE, Georgiou E, Satava RM. 5G Use in Healthcare:

The Future is Present. JSLS. 2021 OctDec;25(4):e2021.00064. doi:

10.4293/JSLS.2021.00064.
6. Elendu C, Elendu TC, Elendu ID. 5G-enabled smart hospitals:

Innovations in patient care and facility management. Medicine

(Baltimore). 2024 May 17;103(20):e38239. doi: 10.1097/MD.0000000000038239

7. Ventola CL. Mobile devices and apps for health care professionals: uses and benefits. P T.

2014 May;39(5):356-64.

8. Ndlovu K, Mars M, Scott RE. Interoperability frameworks linking mHealth applications to

electronic record systems. BMC Health Serv Res. 2021 May 13;21(1):459. doi:

10.1186/s12913-021-06473-6.

9. Ahuja A, Agrawal S, Acharya S, Batra N, Daiya V. Advancements in Wearable Digital

Health Technology: A Review of Epilepsy Management. Cureus. 2024 Mar

27;16(3):e57037. doi: 10.7759/cureus.57037.

10. Esmaeili B, Vieluf S, Dworetzky BA, Reinsberger C. The Potential of Wearable Devices

and Mobile Health Applications in the Evaluation and Treatment of Epilepsy.

Neurol Clin. 2022 Nov;40(4):729-739. doi:

10.1016/j.ncl.2022.03.005.

11. Hosny A, Parmar C, Quackenbush J, Schwartz LH, Aerts HJWL. Artificial intelligence in

radiology. Nat Rev Cancer. 2018 Aug;18(8):500-510. doi: 10.1038/s41568-018-0016-5.

12. Kuziemsky C, Maeder AJ, John O, Gogia SB, Basu A, Meher S, Ito M. Role of Artificial

Intelligence within the Telehealth Domain. Yearb Med Inform. 2019 Aug;28(1):35-40.

doi: 10.1055/s-0039-1677897.

13. Park HS, Kim KI, Soh JY, Hyun YH, Lee BE, Lee JH, Jo JG, Lee HC, Kim HS.

Development and Operation of a Video Teleconsultation System Using Integrated Medical

Equipment Gateway: a National Project for Workers in Underserved Areas. J Med Syst.

2020 Oct 1;44(11):194. doi: 10.1007/s10916-020-01664-w.

14. Weber AM, Dua A, Chang K, Jupalli H, Rizwan F, Chouthai A, Chen C. An outpatient

telehealth elective for displaced clinical learners during the COVID-19 pandemic. BMC

Med Educ. 2021 Mar 20;21(1):174. doi: 10.1186/s12909-02102604-z.

15. Ko HYK, Tripathi NK, Mozumder C, Muengtaweepongsa S, Pal I. Real-Time Remote

Patient Monitoring and Alarming System for Noncommunicable Lifestyle Diseases. Int J

Telemed Appl. 2023 Nov 20;2023:9965226. doi: 10.1155/2023/9965226.

16. Hassan SR, Ahmad I, Ahmad S, Alfaify A, Shafiq M. Remote Pain Monitoring Using Fog

Computing for e-Healthcare: An Efficient Architecture. Sensors (Basel). 2020 Nov

18;20(22):6574. doi: 10.3390/s20226574.

17. Wilson C, Campbell SM, Luker KA, Caress AL. Referral and management options for

patients with chronic kidney disease: perspectives of patients, generalists and specialists.

Health Expect. 2015 Jun;18(3):325-34. doi: 10.1111/hex.12025.

18. Gray KE, Rao M, Gunnink E, Eschenroeder L, Geyer JR, Nelson KM, Reddy A. Home

Telehealth in the Veterans

Health Administration: Trends and Correlates of Length of Enrollment from 2010 to 2017.

J Gen Intern Med. 2022 Sep;37(12):3089-3096. doi: 10.1007/s11606-022-07452-1.

19. Bowles KH, Riegel B, Weiner MG, Glick H, Naylor MD. The effect of telehomecare on

heart failure self care. AMIA Annu Symp Proc. 2010 Nov 13;2010:71-5.

20. Raposo VL. Telemedicine: The legal framework (or the lack of it) in Europe. GMS Health

Technol Assess. 2016 Aug 16;12:Doc03. doi: 10.3205/hta000126.

21. Agarwal N, Jain P, Pathak R, Gupta R. Telemedicine in India: A tool for transforming

health care in the era of COVID-19 pandemic. J Educ Health Promot. 2020 Jul 28;9:190.

doi: 10.4103/jehp.jehp_472_20.

22. Royce TJ, Sanoff HK, Rewari A. Telemedicine for Cancer Care in the Time of COVID-

19. JAMA Oncol. 2020 Nov 1;6(11):1698-1699. doi: 10.1001/jamaoncol.2020.2684.

23. Solimini R, Busardò FP, Gibelli F, Sirignano A, Ricci G. Ethical and Legal Challenges of

Telemedicine in the Era of the COVID-19 Pandemic. Medicina (Kaunas). 2021 Nov

30;57(12):1314. doi: 10.3390/medicina57121314.

24. Nittari G, Khuman R, Baldoni S, Pallotta G, Battineni G, Sirignano A, Amenta F, Ricci G.

Telemedicine Practice: Review of the Current Ethical and Legal Challenges. Telemed

J E Health. 2020 Dec;26(12):1427-1437. doi:

10.1089/tmj.2019.0158.

25. Salmanizadeh F, Ameri A, Bahaadinbeigy K. Methods of Reimbursement for

Telemedicine Services: A Scoping Review. Med J Islam Repub Iran. 2022 Jun 22;36:68.

doi: 10.47176/mjiri.36.68.

26. Antoniotti NM, Drude KP, Rowe N. Private payer telehealth reimbursement in the United

States. Telemed J E Health. 2014 Jun;20(6):539-43. doi: 10.1089/tmj.2013.0256.

27. Dahl-Popolizio S, Carpenter H, Coronado M, Popolizio NJ, Swanson C. Telehealth for the

Provision of Occupational Therapy: Reflections on Experiences During the COVID-19

Pandemic. Int J Telerehabil. 2020 Dec 8;12(2):77-92. doi: 10.5195/ijt.2020.6328.

28. Angelopoulou E, Papachristou N, Bougea A, Stanitsa E, Kontaxopoulou D, Fragkiadaki S,

et al. How Telemedicine Can Improve the Quality of Care for Patients with Alzheimer's

Disease and Related Dementias? A Narrative Review. Medicina (Kaunas). 2022 Nov

22;58(12):1705. doi: 10.3390/medicina58121705.

29. Molfenter T, Heitkamp T, Murphy AA, Tapscott S, Behlman S, Cody OJ. Use of

Telehealth in Mental Health (MH) Services During and After COVID-19. Community

Ment Health J. 2021 Oct;57(7):1244-1251. doi: 10.1007/s10597021-00861-2.

30. Greenwood H, Krzyzaniak N, Peiris R, Clark J, Scott AM, Cardona M, Griffith R,

Glasziou P. Telehealth Versus Faceto-face Psychotherapy for Less Common Mental

Health Conditions: Systematic Review and Meta-analysis of Randomized Controlled

Trials. JMIR Ment Health. 2022 Mar 11;9(3):e31780. doi: 10.2196/31780.

31. Wosik J, Fudim M, Cameron B, Gellad ZF, Cho A, Phinney D, Curtis S, Roman M, Poon

EG, Ferranti J, Katz JN, Tcheng J. Telehealth transformation: COVID-19 and the rise of

virtual care. J Am Med Inform Assoc. 2020 Jun 1;27(6):957-962. doi:

10.1093/jamia/ocaa067.

32. Shaver J. The State of Telehealth Before and After the COVID-19 Pandemic. Prim Care.

2022 Dec;49(4):517-530. doi: 10.1016/j.pop.2022.04.002.

33. O'Cathail M, Sivanandan MA, Diver C, Patel P, Christian J. The Use of Patient-Facing

Teleconsultations in the National Health Service: Scoping Review. JMIR Med Inform.

2020 Mar 16;8(3):e15380. doi: 10.2196/15380.

34. Sibal A, Mohta NS. Apollo Hospitals’ Response to Covid-19 in India: Behind the Scenes.

NEJM Catal Innov Care Deliv.

2021 Jun 16;2(7):10.1056/CAT.21.0214. doi:

10.1056/CAT.21.0214.

35. Ftouni R, AlJardali B, Hamdanieh M, Ftouni L, Salem N. Challenges of Telemedicine

during the COVID-19 pandemic: a systematic review. BMC Med Inform Decis Mak. 2022

Aug 3;22(1):207. doi: 10.1186/s12911-022-01952-0.

36. Sharma A, Pruthi M, Sageena G. Adoption of telehealth technologies: an approach to

improving healthcare system. Transl Med Commun. 2022;7(1):20. doi:

10.1186/s41231022-00125-5.

37. Burstin H, Clark KJ, Duff N, Dopp AL, Bentley E, Wattenberg S, et al. Integrating

Telehealth and Traditional

Care in Chronic Pain Management and Substance Use Disorder Treatment: An Action

Agenda for Building the Future State of Hybrid Care. NAM Perspect. 2023 Oct

26;2023:10.31478/202310b. doi: 10.31478/202310b.

38. Aguirre RR, Suarez O, Fuentes M, Sanchez-Gonzalez MA. Electronic Health Record

Implementation: A Review of Resources and Tools. Cureus. 2019 Sep 13;11(9):e5649.

doi: 10.7759/cureus.5649.

39. Dinesen B, Nonnecke B, Lindeman D, Toft E, Kidholm K, Jethwani K, et al. Personalized

Telehealth in the Future: A Global Research Agenda. J Med Internet Res. 2016 Mar

1;18(3):e53. doi: 10.2196/jmir.5257.

40. Anawade PA, Sharma D, Gahane S. A Comprehensive Review on Exploring the Impact of

Telemedicine on Healthcare Accessibility. Cureus. 2024 Mar 12;16(3):e55996. doi:

10.7759/cureus.55996.

41. Purohit A, Smith J, Hibble A. Does telemedicine reduce the carbon footprint of

healthcare? A systematic review. Future Healthc J. 2021 Mar;8(1):e85-e91. doi:

10.7861/fhj.

42. Borzo G.internet infuse new life into data Network. American Medical New. May 20,

1996b.p.3.p.27.

43. Bovbjerg R. Legislation on medical malpractice; further developments and a report

card university of California at davis law review. 1989;22;499560.

44. Barly D. Colorado facilities evaluate telemedicine to cut transportation. Health

management technology. 1995;16[2];64-70.

45. Brecht RM, Gray CL ,Peterson C, et al. the university of Texas medical branch-texas

department of criminal justice telemedicine project. Telemedicine journal. 1996;2[1];25-

35.

46. Brenner MH, curbow B, legro MW. The case of cataract surgery. Medical care.

1995;33[4, suppl];AS236-AS244.

47. Briggs A, Sculpher M, Buxton M. uncertainty in the economic evaluation of health

care technologies; the role of sensitivity analysis. Health economics. 1994;3[2];95-104.

48. Brook RH, lohr kn. Efficacy, effectiveness variations, and quality boundary-crossing

research. Medical care.1985;23;710-722.

49. Campbell DT, Stanley JC. Experimental and quasi-experimental designs for research.

Chicago; rand MCNally; 1963.

50. Cap [college of American pathologists ]. Systematized nomenclature of medicine.

Cote RA, editor. Skokie, III; CAP; 1993.

51. Carey RG, seibert JH. A patient survey system to measure quality improvement;

questionnaire reliability and validity. Medical care.1993;31[9];834-845.

52. Carthy Z. emergency tele-home health care. Telemedicine today. 1995;3[4];10-11.

53. CBO [Congressional budget office]. Physician reimbursement under medicare;

options for change. Washington, D.C; CBO; Apr, 1986.

54. Chester town roundtable. Briefing book; developing approaches for DOD technology

assessment and evaluation of telemedicine. Sponsore by the army medical and material

development command and the ISIS center, Georgetown university medical center;

Chestertown, Md. July 20-august 1, 1995;

55. Chinnock C. providers plow new ground by extending services to prison.

Telemedicine and telehealth networks. 1996;2[2];32.35.

56. CHPS[Center for health policy studies]. Final report to the agency for health care

policy and research [contract no.282-92-0038]. Rockville, Md; jan, 1995.understanding

and choosing clinical performance measures for quality improvement; development of a

typology.

57. Cleary PD, mcneil BJ. Patient satisfaction as an indicator of qulity care.inquiry.

1988;25;25-26.

58. Collins JM, charboneau W. long distance pricedures; legal, licensing and

reimbursement issues. Proceedings of the mayo telemedicine symposium;broadcast

simultaneously from rochestwr, minn., Jacksonville, fla., and Scottsdale, ariz. October 1-3,

1993; Rochester;mayo clinic; pp.56-60.