Telemedicine - is the cart being put before the horse?

Nigel R Armfield, Sisira K Edirippulige, Natalie Bradford and Anthony C Smith
Med J Aust 2014; 200 (9): 530-533. || doi: 10.5694/mja13.11101


  • A large literature base on telemedicine exists, but the evidence base for telemedicine is very limited. There is little practical or useful information to guide clinicians and health policymakers.
  • Telemedicine is often implemented based on limited or no prior formal analysis of its appropriateness to the circumstances, and adoption of telemedicine by clinicians has been slow and patchy.
  • Formal analysis should be conducted before implementation of telemedicine to identify the patients, conditions and settings that it is likely to benefit.
  • Primary studies of telemedicine tend to be of insufficient quality to enable synthesis of formal evidence.
  • Methods typically used to assess effectiveness in medicine are often difficult, expensive or impractical to apply to telemedicine.
  • Formal studies of telemedicine should examine efficacy, effectiveness, economics and clinician preferences.
  • Successful adoption and sustainable integration of telemedicine into routine care could be improved by evidence-based implementation.

Please login with your free MJA account to view this article in full

  • Nigel R Armfield1,2
  • Sisira K Edirippulige1
  • Natalie Bradford1,0,2
  • Anthony C Smith1,2

  • 1 Centre for Online Health, School of Medicine, University of Queensland, Brisbane, QLD.
  • 2 Queensland Children's Medical Research Institute, Brisbane, QLD.


Competing interests:

No relevant disclosures.

  • 1. Fatehi F, Wootton R. Telemedicine, telehealth or e-health? A bibliometric analysis of the trends in the use of these terms. J Telemed Telecare 2012; 18: 460-464.
  • 2. Ekeland AG, Bowes A, Flottorp S. Effectiveness of telemedicine: a systematic review of reviews. Int J Med Inform 2010; 79: 736-771.
  • 3. McCartney M. Show us the evidence for telehealth. BMJ 2012; 344: e469.
  • 4. Oliver D. Over-claiming the evidence for telehealth and telecare [letter]? BMJ 2013; 346: f3377.
  • 5. Mistry H. Systematic review of studies of the cost-effectiveness of telemedicine and telecare. Changes in the economic evidence over twenty years. J Telemed Telecare 2012; 18: 1-6.
  • 6. Wade VA, Karnon J, Elshaug AG, Hiller JE. A systematic review of economic analyses of telehealth services using real time video communication. BMC Health Serv Res 2010; 10: 233.
  • 7. Peeters JM, Mistiaen P, Francke AL. Costs and financial benefits of video communication compared to usual care at home: a systematic review. J Telemed Telecare 2011; 17: 403-411.
  • 8. Moreno L, Dale SB, Chen AY, Magee CA. Costs to Medicare of the Informatics for Diabetes Education and Telemedicine (IDEATel) home telemedicine demonstration: findings from an independent evaluation. Diabetes Care 2009; 32: 1202-1204.
  • 9. Oakley AM, Kerr P, Duffill M, et al. Patient cost-benefits of realtime teledermatology — a comparison of data from Northern Ireland and New Zealand. J Telemed Telecare 2000; 6: 97-101.
  • 10. Armfield NR, Donovan T, Bensink ME, Smith AC. The costs and potential savings of telemedicine for acute care neonatal consultation: preliminary findings. J Telemed Telecare 2012; 18: 429-433.
  • 11. Loh PK, Sabesan S, Allen D, et al. Practical aspects of telehealth: financial considerations. Intern Med J 2013; 43: 829-834.
  • 12. Wade V, Eliott J, Karnon J, Elshaug AG. A qualitative study of sustainability and vulnerability in Australian telehealth services. Stud Health Technol Inform 2010; 161: 190-201.
  • 13. Zanaboni P, Wootton R. Adoption of telemedicine: from pilot stage to routine delivery. BMC Med Inform Decis Mak 2012; 12: 1.
  • 14. Smith AC, Armfield NR, Croll J, Gray LC. A review of Medicare expenditure in Australia for psychiatric consultations delivered in person and via videoconference. J Telemed Telecare 2012; 18: 169-171.
  • 15. Australian Government Department of Health. MBS video consultation items. (accessed Nov 2013).
  • 16. Smith AC, Armfield NR, Gray LC. Retrospective review of Medicare reimbursement for telehealth in Australia [abstract]. In: Abstracts from the American Telemedicine Eighteenth Annual International Meeting and Exposition. Telemed J E Health 2013; 19: A1-A134.
  • 17. Gagnon MP, Duplantie J, Fortin JP, Landry R. Implementing telehealth to support medical practice in rural/remote regions: what are the conditions for success? Implement Sci 2006; 1: 18.
  • 18. Coiera E. Medical informatics. BMJ 1995; 310: 1381-1387.
  • 19. Australian Bureau of Statistics. Regional population growth, Australia, 2012–13. Canberra: ABS, 2013. (ABS Cat. No. 3218.0.) (accessed Dec 2013).
  • 20. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307-310.
  • 21. Ekeland AG, Bowes A, Flottorp S. Methodologies for assessing telemedicine: a systematic review of reviews. Int J Med Inform 2012; 81: 1-11.
  • 22. Nutbeam D, Boxall AM. What influences the transfer of research into health policy and practice? Observations from England and Australia. Public Health 2008; 122: 747-753.
  • 23. Head BW. Three lenses of evidence-based policy. Aust J Publ Admin 2008; 67: 1-11.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.