How to evaluate the effectiveness of telemedicine?

Factors to be considered when evaluating the effectiveness of telemedicine include:

Access to care 

• Does the telemedicine service help overcome barriers to accessing healthcare – whether geographical, physical mobility, time or financial constraints? 
• Do new technologies create any unintended barriers and how can these be overcome?

Quality of care

• What is the effect on communication and interactions between patients and providers? 
• Is continuity of care improved?
• How is the monitoring and management for chronic diseases affected?

Patient experience 

• What is the feedback from patients on using the service?
• How does telemedicine impact patient satisfaction and convenience?

Waiting times

• What is the impact of telemedicine on waiting times for appointments?

Physician experience

• What is the experience of  physicians and other staff?
• Are workflows and administrative work streamlined?

Clinical outcomes 

As telemedicine is most often used, and most effective, as part of a hybrid service combined with in-person consultations and treatment, it may be difficult to assess how virtual care provision affects overall clinical outcomes. However, the following questions may help assess the effect of telemedicine on clinical outcomes:

• Are signs or symptoms indicating the need for intervention detected earlier?
• What is the effect on follow-up and patient compliance?
• Are patients more empowered to take care of their own health and make lifestyle changes?
• Does the use of video-conferencing and easier sharing of medical records increase collaboration among health professionals?

Patient safety 

• Is telemedicine being used for appropriate consultations and patients?
• Does improved monitoring via telemedicine enable time-critical interventions to be provided earlier?  
• Have any unintended adverse events occurred due to problems with the design or use of  telemedicine systems?
• Have virtual visits reduced the transmission of infectious diseases?

Data security

• Are systems fully compliant with local data protection regulations, such as  HIPAA and GDPR?
• Have there been any data breaches? If so, have these been rectified?

Financial considerations

• What is the relationship between start-up, running costs and  reimbursement and revenue streams from telemedicine? 
• What cost efficiencies does the use of telemedicine enable? 

Which methods can be used to evaluate effectiveness?

1. Questionnaires or surveys

The questionnaires most commonly used to evaluate telemedicine are:

• Telehealth Usability Questionnaire (TUQ) – for both patients and physicians – asks about usefulness, ease of use, interface quality, interaction quality, reliability, satisfaction and future use.
• Telemedicine Satisfaction Questionnaire (TSQ) – covers various satisfaction factors such as the quality of care, quality of virtual visits and interpersonal interactions.

2. Clinical outcome data 

As stated previously, where care is provided both in-person and virtually, it may not be possible to attribute certain outcomes solely to the use of telemedicine. Comparisons may be made between outcomes before and after the introduction of video consultations and remote monitoring.

3. Implementation and performance analysis 

Analysis of patient numbers, clinic workflows, use of clinic and staff time, online consent procedure, technical aspects etc.

4. Cost-benefit analysis

• Return on investment in new technologies for healthcare providers.
• Analysis of treatment costs and associated expenditure.