The telemedicine intervention in chronic disease management promises to involve patients in their own care, provides continuous monitoring by their healthcare providers, identifies early symptoms, and responds promptly to exacerbations in their illnesses. This review set out to establish the evidence from the available literature on the impact of telemedicine for the management of three chronic diseases: congestive heart failure, stroke, and chronic obstructive pulmonary disease. By design, the review focuses on a limited set of representative chronic diseases because of their current and increasing importance relative to their prevalence, associated morbidity, mortality, and cost. Furthermore, these three diseases are amenable to timely interventions and secondary prevention through telemonitoring. The preponderance of evidence from studies using rigorous research methods points to beneficial results from telemonitoring in its various manifestations, albeit with a few exceptions. Generally, the benefits include reductions in use of service: hospital admissions/re-admissions, length of hospital stay, and emergency department visits typically declined. It is important that there often were reductions in mortality. Few studies reported neutral or mixed findings.

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Bodenheimer T, Chen E, Bennett HD. Confronting the growing burden of chronic disease: Can the U.S. health care workforce do the job? Health Aff (Millwood) 2009;28:64–74.
Trans Am Med Assoc 1848;1:101–133.
Johnson C, Conway J, Talliaferro H. Report on the number of practitioners in Virginia. Trans Am Med Assoc 1848;1:359–364.
Lyon E. Further data on the alleged lack of physicians and distribution of irregular practitioners. JAMA 1923;80:718.
Smith H, Warnshuis F. The distribution of physicians in relation to population—A statistical survey and study covering ten years (1913–1924). J Mich Med Soc 1926;25:89–94.
Carroll A. Too few physicians doesn't necessarily mean too many specialists. June 16, 2013. news@JAMA. Available at http://theincidentaleconomist.com/wordpress/jama-forum-too-few-generalist-physicians-doesnt-necessarily-mean-too-many-specialists (last accessed May 1, 2014).
Young A, Chaudhry H, Thomas J, et al. A census of actively licensed physicians in the United States, 2012. J Med Reg 2013;99:11–24.
Bashshur R, Shannon G. History of telemedicine: Evolution, context and transformation. New Rochelle, NY: Mary Ann Liebert, Inc., 2009.
Howitt A. The native tribes of South-Eastern Australia. New York: MacMillan and Company, 1904.
Fine L. Circle of urine glasses: Art of uroscopy. Am J Nephrol 1986;6:307–311.
Wild W. Doctor-patient correspondence in eighteenth-century Britain: A change in rhetoric and relationship. Stud Eighteenth Century Culture 2000;29:47–64.
Jepsen T. My sisters telegraphic: Women in the telegraph office, 1846–1950. Athens, OH: Ohio University Press, 2000.
Letter to the editor. Lancet 1879; (Nov).
Einthoven W. Het telecardiogram [The telecardiogram]. Ned Tijd Geenesk 1906;6:307–311.
Brown SG. A telephone relay. J Inst Electr Eng 1910;45:590–601.
James W, Williams H. The electrocardiogram in clinical medicine. Am J Med Sci 1910;140:408–421, 644–669.
Rafto T. Telegrafverkets historie: 1855–1955. Bergen, Norway: John Griegs Boktr, 1955.
Elford DR. Telemedicine in northern Norway. J Telemed Telecare 1997;3:1–22.
Goethe WHG. Medical care on ships without a doctor—Radio medical advice. In: Handbook of nautical medicine. Berlin: Springer, 1984:53–65.
Gershon-Cohen J, Cooley AG. Telognosis, three year experience with diagnosis by telephone-transmitted roentgenograms. Radiology 1950;55:582–587.
Jutras A, Duckett G. Distant radiodiagnosis; telefluoroscopy & cinefluorography. Union Med Canada 1957;86:1284–1289.
Wittson CL, Dutton R. A new tool in psychiatric education. Mental Hosp 1955;11:35–38.
Bashshur R, Shannon G, Sapci H. Telemedicine evaluation. Telemed J E Health 2005;11:296–316.
Chronic disease prevention and health promotion. Available at www.CDC.gov/chronicdisease/overview/index.htm (last accessed March 25, 2014).
Woolliscroft J, Koelling TM. Redesigning the management of chronic illness. Telemed J E Health 2004;10:118–121.
Wagner EH. Managed care and chronic illness: Health services research needs. Health Serv Res 1997;32:702.
Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA 2002;288:1775–1779.
Coleman K, et al. Evidence on the chronic care model in the new millennium. Health Aff (Millwood) 2009;28:75–85.
American Heart Association. About heart failure. Available at www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/About-Heart-Failure_UCM_002044_Article.jsp (last accessed February 15, 2014).
McMurray J, Adamopoulos S, Arker S, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur J Heart Fail 2012;14:803–869.
American Heart Association. Classification of functional capacity and objective assessment. Available at https://my.americanheart.org/professional/StatementsGuidelines/ByPublicationDate/PreviousYears/Classification-of-Functional-Capacity-and-Objective-Assessment_UCM_423811_Article.jsp (last accessed February 22, 2014).
Horsley L. ACC and AHA update on chronic heart failure guidelines. Am Fam Physician 2010;81:654–665.
Mahmood SS, Wang TJ. The epidemiology of congestive heart failure: Contributions from the Framingham Heart Study. Global Heart 2013;8:77–82.
Rathi S, Deedwania PC. The epidemiology and pathophysiology of heart failure. Med Clin North Am 2012;96:881–890.
Zarrinkoub R, Wettermark B, Wändell P, Mejhert M, Szulkin R, Ljunggren G, Kahan T. The epidemiology of heart failure, based on data for 2.1 million inhabitants in Sweden. Eur J Heart Fail 2013;15:995–1002.
Wong YW, Felker GM. Etiology and overview of heart failure. In: Krum H, von Lueder T, eds. Advances in heart failure management. London: Future Medicine, Ltd., 2012;6–17.
He J, Ogden L, Bazzano L, et al. Risk factors for congestive heart failure in U.S. men and women (NHANES1 Epidemiologic Follow-up Study). Arch Intern Med 2001;161:996–1002.
Heidenreich P, Trogdon J, Khavjou O, et al. Forecasting the future of cardiovascular disease in the United States: A policy statement from the American Heart Association. Circulation 2011;123:933–944.
Lloyd-Jones D, Larson M, Leip E, et al. Lifetime risk for developing congestive heart failure: The Framingham Heart Study. Circulation 2002;106:3068–3072.
Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics—2013 update: A report from the American Heart Association. Circulation 2013;127:e6-e245.
Lloyd-Jones D, Adams R, Brown T, et al. Heart disease and stroke statistics—2010 update: A report from the American Heart Association. Circulation 2012;121:e46–e215.
Morbidity and mortality: 2012 chart book on cardiovascular and lung diseases. Bethesda, MD: National Heart Lung and Blood Institute, 2012.
Johnston B, Wheeler L, Deuser J, et al. Outcomes of the Kaiser Permanente tele-home health research project. Arch Fam Med 2000;9:40–45.
Riegel B, Carlson B, Kopp C, et al. Effect of a standardized case-management telephone intervention on resource use in patients with chronic heart failure. Arch Intern Med 2002;162:705–712.
Goldberg LR, Piette JD, Walsh MN, et al. Randomized trial of a daily electronic home monitoring system in patients with advanced heart failure: The Weight Monitoring in Heart Failure (WHARF) trial. Am Heart J 2003;146:705–712.
Cleland JG, Louis AA, Rigby AS, et al. Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: The Trans-European Network-Home-Care Management System (TEN-HMS) study. J Am Coll Cardiol 2005;45:1654–1664.
Woodend AK, Sharrard H, Fraser M, et al. Telehome monitoring in patients with cardiac disease who are at high risk of readmission. Heart Lung 2008;37:36–45.
Darkins A, Ryan P, Kobb R, et al. Care coordination/home telehealth: The systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemed J E Health 2008;14:1118–1126.
Dendale P, De Keulenaer G, Troisfontaines P, et al. Effect of a telemonitoring-facilitated collaboration between general practitioner and heart failure clinic on mortality and rehospitalization rates in severe heart failure: The TEMA-HF 1 (TElemonitoring in the MAnagement of Heart Failure) study. Eur J Heart Fail 2012;14:333–340.
Ferrante D, Varini S, Macchia A, et al. Long-term results after a telephone intervention in chronic heart failure: DIAL (randomized trial of phone intervention in chronic heart failure) follow-up. J Am Coll Cardiol 2010;56:372–378.
Weintraub A, Gregory D, Patel A, et al. A multicenter randomized controlled evaluation of automated home monitoring and telephonic disease management in patients recently hospitalized for congestive heart failure: The SPAN-CHF II trial. J Card Fail 2010;16:285–292.
Chaudhry SI, Mattera JA, Curtis JP, et al. Telemonitoring in patients with heart failure. N Engl J Med 2010;363:2301–2309.
Giordano A, Zanelli E, Scalvini S. Home-based telemanagement in chronic heart failure: An 8-year single site experience. J Telemed Telecare 2011;17:382–386.
Koehler F, Winkler S, Shieber M, et al. Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure. Circulation 2011;123:1873–1880.
Landolina M, Perego G, Lunati M, et al. Remote monitoring reduces healthcare use and improves quality of care in heart failure patients with implantable defibrillators: The evolution of management strategies of heart failure patients with implantable defibrillators (EVOLVO) study. Circulation 2012;125:2985–2992.
Chen YH, Ho YL, Huang HC, et al. Assessment of the clinical outcomes and cost-effectiveness of the management of systolic heart failure in Chinese patients using a home-based intervention. J Int Med Res 2010;38:242–252.
Boyne JJ, Vrijhoef HJ, Crijns HJ, et al. Tailored telemonitoring in patients with heart failure: Results of a multicentre randomized controlled trial. Eur J Heart Fail 2012;14:791–801.
Steventon A, Bardsley M, Billings J, et al. Effect of telehealth on use of secondary care and mortality: Findings from the Whole System Demonstrator cluster randomised trial. BMJ 2012;344:e3874.
Baker LC, Johnson SJ, Macaulay D, et al. Integrated telehealth and care management program for Medicare beneficiaries with chronic disease linked to savings. Health Aff (Millwood) 2011;30:1689–1697.
Baker LC, Macaulay L, Sorg R, Diener M, et al. Effects of care management and telehealth: A longitudinal analysis using Medicare data. J Am Geriatr Soc 2013;61:1560–1567.
Takahashi P, Pecina J, Upatising B, et al. A randomized controlled trial of telemonitoring in older adults with multiple health issues to prevent hospitalizations and emergency department visits. Arch Intern Med 2012;172:773–780.
Wilson S. Another sobering result for home telehealth—And where we might go next. Arch Intern Med 2012;172:779–780.
American Heart Association/American Stroke Association. About stroke. 2012. Available at www.strokeassociation.org/STROKEORG/AboutStroke/About-Stroke_UCM_308529_SubHomePage.jsp (last accessed February 25, 2014).
National Institute of Neurological Disorders and Stroke. NINDS stroke information page. 2014. Available at www.ninds.nih.gov/disorders/stroke/stroke.htm (last accessed February 25, 2014).
Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics—2014 update: A report from the American Heart Association. Circulation 2014;129:e28–e292.
National Institutes of Health. Stroke fact sheet. 2010. Available at http://report.nih.gov/nihfactsheets/Pdfs/Stroke(NINDS).pdf (last accessed April 21, 2014).
Murphy SL, Xu J, Kochanek KD. Deaths: Final data for 2010. Natl Vital Stat Rep 2013;61(4):1–118.
Kjellstrom T, Norrving B, Shatchukute A, eds. Helsingborg Declaration 2006 on European Stroke Strategies. Cerebrovasc Dis 2007;23:229–241.
Das R, Seshadri S, Beiser A, et al. Prevalence and correlates of silent cerebral infarcts in the Framingham Offspring study. Stroke 2008;39:2929–2935.
Vermeer W, Longstreth W, Koudstaal P. Silent brain infarcts: A systematic review. Lancet Neurol 2007;6:611–619.
Howard V, Kleindorfer D, Judd S, et al. Disparities in stroke incidence contribution to disparities in stroke mortality. Ann Neurol 2011;69:619–627.
Ovbiagele B, Goldstein L, Higashida R, et al. Forecasting the future of stroke in the United States: A policy statement from the American Heart Association and American Stroke Association. Stroke 2013;44:2361–2375.
Seshadri S, Beiser A, Kelly-Hayes M, et al. The lifetime risk of stroke: Estimates from the Framingham Study. Stroke 2006;37:345–350.
Morgenstern L, Smith M, Lisabeth L, et al. Excess stroke in Mexican American compared with non-Hispanic whites: The Brain Attack Surveillance in Corpus Christi Project. Am J Epidemiol 2004;160:376–383.
National Stroke Association. Am I at risk for stroke: Stroke risk factors. Available at www.stroke.org/site/PageServer?pagename=risk (last accessed March 2, 2014).
Demaerschalk BM, Hwang HM, Leung G. US cost burden of ischemic stroke: A systematic literature review. Am J Manag Care 2010;16:525–533.
Caro J, Huybrechts K, Duschesne I. Management patterns and costs of acute ischemic stroke: An international study. Stroke 2003;31:582–590.
Brown DL, Boden-Albala B, Langa KM, et al. Projected costs of ischemic stroke in the United States. Neurology 2006;67:1390–1395.
Partridge M. Costs of ischemic stroke projected to rise. Physicians Practice. 2006. Available at www.physicianspractice.com (last accessed April 24, 2014).
Brinjikji W, Rabinstein A, Cloft H. Hospitalization costs for acute ischemic stroke patients treated with intravenous thrombolysis in the United States are substantially higher than Medicare payments. Stroke 2012;43:1131–1133.
Levine SR, Gorman M. “Telestroke”: The application of telemedicine for stroke. Stroke 1999;30:464–469.
Khan K, Shuaib A, Whittaker T, et al. Telestroke in Northern Alberta: A two year experience with remote hospitals. Can J Neurol Sci 2010;37:808–813.
Gonzalez M, Hanna N, Rodrigo M, et al. Reliability of prehospital real-time cellular video phone in assessing the simplified National Institutes of Health Stroke Scale in patients with acute stroke: A novel telemedicine technology. Stroke 2011;42:1522–1527.
Demaerschalk B, Vegunta S, Vargas B, et al. Reliability of real-time video smartphone for assessing National Institutes of Health Stroke Scale scores in acute stroke patients. Stroke 2012;43:3271–3277.
Allibert R, Ziegler F, Bataillard M, Gomes C, Jary A, Moulin T. Telemedicine and fibrinolysis in France-Comte [in French]. Rev Neurol (Paris) 2012;168:40–48.
Pervez MA, Silva G, Masrur S, et al. Remote supervision of IV-tPA for acute ischemic stroke by telemedicine and telephone prior to a regional stroke center is feasible and safe. Stroke 2010;41:e18–e24.
Spokoyny I, Raman R, Ernstrom K, et al. Pooled assessment of computed tomography interpretation by vascular neurologists in the STRokE DOC Telestroke Network. J Stroke Cerebrovasc Dis 2014;23:511–515.
Demaerschalk B, Roman R, Enstrom K, et al. Efficacy of telemedicine for stroke: Pooled analysis of the stroke team remote evaluation using a digital observation camera (STRoKE DOC) Arizona telestroke trials. Telemed J E Health 2012;18:230–237.
Handschu R, Scibor M, Willasczek B, et al. Telemedicine in acute stroke, remote video-examination compared to simple telephone consultation. J Neurol 2008;255:1792–1797.
Puetz V, Bodechtel U, Gerber C, et al. Reliability of brain CT evaluation by stroke neurologists in telemedicine. Neurology 2012;80:332–338.
Muller H, Nimmrichter B, Schenkel J, et al. Improvement in stroke care in a non-urban community hospital—Quality of procedures before and after participating in a telemedical stroke network [in German]. Dtsch Med Wochenschr 2006;131:1309–1314.
Audebert H, Tietz V, Boy S, et al. Acceptance of telemedicine for acute stroke care. The German Project TEMPiS [in German]. Nervenarzt 2009;80:184–189.
Pedragosa A, Alvarez-Sabin J, Molina C, et al. Impact of a telemedicine system on acute stroke care in a community hospital. J Telemed Telecare 2009;15:260–263.
Nagao KJ, Koschel A, Haines HM, et al. Rural Victorian Telestroke project. Intern Med J 2012;42:1088–1095.
Sairanen T, Soinila S, Nikkanen M, et al. Two years of Finnish telestroke thrombolysis at spokes equal to that at the hub. Neurology 2011;76.13:1145–1152.
Rudd M, Rodgers H, Curless R, et al. Remote specialist assessment for intravenous thrombolysis of acute ischaemic stroke by telephone. Emerg Med J 2014;29:704–708.
Bruno A, Lanning K, Gross H, et al. Timeliness of intravenous thrombolysis via telestroke in Georgia. Stroke 2013;44:2620–2622.
Pedragosa A, Alvarez-Sabin J, Rubiera M. Impact of telemedicine on acute management of stroke patients undergoing endovascular procedures. Cerebrovasc Dis 2012;34:436–442.
Walter S, Kostopoulos P, Haass A, et al. Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: A randomized controlled trial. Lancet Neurol 2012;11:397–404.
Audebert H, Schultes K, Tietz V, et al. Long-term effects of specialized stroke care with telemedicine support in community hospitals on behalf of the Telemedical Project for Integrative Stroke Care (TEMPiS). Stroke 2009;40:902–908.
Theiss S, Gunzel F, Storm A, et al. Using routine data for quality assessment in NeuroNet telestroke care. J Stroke Cerebrovasc Dis 2013;22:984–990.
Switzer J, Demaerschalk B, Xie J, et al. Cost effectiveness of hub-and-spoke telestroke networks for the management of acute ischemic stroke from the hospitals' perspectives. Circ Cardiovasc Qual Outcomes 2013;6:18–26.
GOLD. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Workshop Report, April 2001. NIH publication no. 2701:1-100. Bethesda, MD: National Heart, Lung and Blood Institute, updated 2014.
Caramori G, Adcock I, Papi A. Clinical definition of COPD exacerbations and classification of their severity. South Med J 2009;102:277–282.
Donaldson G, Wedzicha J. COPD exacerbations 1: Epidemiology. Thorax 2006;61:164–168.
Rodriguez-Roisin R. Toward a consensus definition for COPD exacerbations. Chest 2000;117(5 Suppl 2):398S–401S.
Burge S, Wedzicha JH. COPD exacerbations: Definitions and classifications. Eur Respir J Suppl 2003;41:46s–53s.
Celli B, Barnes P. Exacerbations of chronic obstructive pulmonary disease. Eur Respir J 2007;29:1224–1238.
Rabe K, Hurd S, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007;176:532–555.
Centers for Disease Control and Prevention. Chronic obstructive pulmonary disease among adults—United States, 2011. MMWR Morb Mortal Wkly Rep 2012;61:938–951.
Centers for Disease Control and Prevention. QuickStats: Number of deaths from 10 leading causes—National vital statistics system, United States, 2010. MMWR Morb Mortal Wkly Rep 2013;62:155.
American Lung Association. Trends in COPD (chronic bronchitis and emphysema): Morbidity and mortality. Washington, DC: American Lung Association, Epidemiology and Statistics Unit, Research and Education Division, 2013.
Ford E, Croft J, Mannino D, et al. COPD surveillance—United States, 1999–2011. Chest 2013;144:284–305.
Holguin F, Folk E, Redd SC, Mannino DM. Comorbidity and mortality in COPD-related hospitalizations in the United States, 1979 to 2001. Chest 2005;128:2005–2011.
Raza T, Joshi M, Shapira RM, Agha Z. Pulmonary telemedicine—A model to access the subspecialist services in underserved rural areas. Int J Med Inform 2009;78:53–59.
Bonavia M, Averame G, Canonica W, et al. Feasibility and validation of telespirometry in general practice: The Italian Alliance study. Respir Med 2009;103:1732–1737.
Averame G, Bonavia M, Ferri P, et al. Office spirometry can improve the diagnosis of obstructive airway disease in primary care setting. Respir Med 2009;103:866–872.
Bernocchi P, Scalvini S. Tridico C, et al. Healthcare continuity from hospital to territory in Lombardy: TELEMACO project. Am J Manag Care 2012;18:e101–e108.
Whitten P, Mickus M. Home telecare for COPD/CHF patients: Outcomes and perceptions. J Telemed Telecare 2007;13:69–73.
Vitacca M, Bianchi L, Guerra A, et al. Tele-assistance in chronic respiratory failure patients: A randomized clinical trial. Eur Respir J 2009;33:411–418.
Vitacca M, Bazza A, Bianchi L, et al. Tele-assistance in chronic respiratory failure: Patients' characterization and staff workload of 5-year activity. Telemed J E Health 2010;16:299–305.
Dinesen B, Haesum L, Sorensen N, et al. Using preventive home monitoring to reduce hospital admission rates and reduce costs: A case study of telehealth among chronic obstructive pulmonary disease patients. J Telemed Telecare 2012;18:221–225.
Sorknaes A, Bech M, Madsen H, et al. The effect of real-time teleconsultations between hospital-based nurses and patients with severe COPD discharged after an exacerbation. J Telemed Telecare 2013;19:466–474.
Sorknaes A, Madsen M, Hallas J, et al. Nurse tele-consultation with discharged COPD patients reduce early readmission—An interventional study. Clin Respir J 2011;5:26–34.
Pinnock H, Hanley J, McCloughan L, et al. Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease: Researcher blind, multicentre, randomised controlled trial. BMJ 2013;347:f6070.
Strickland M, Jourdain T, Wong E, et al. Using telehealth technology to deliver pulmonary rehabilitation to patients with chronic obstructive pulmonary disease. Can Respir J 2011;18:216–220.
de Toledo P, Jiménez S, del Pozo F, Roca J, Alonso A, Hernandez C. Telemedicine experience for chronic care in COPD. IEEE Trans Inf Technol Biomed 2006;10:567–573.
Gellis Z, Kenaley B, McGinty J, et al. Outcomes of a telehealth intervention for homebound older adults with heart of chronic respiratory failure: A randomized controlled trial. Gerontologist 2012;52:541–552.
Pedone C, Chiurco D, Scarlata S, et al. Efficacy of multiparametric telemonitoring on respiratory outcomes in elderly people with COPD: A randomized controlled trial. BMC Health Serv Res 2013;13:82.
Cardozo L, Steinberg J. Telemedicine for recently discharged older patients. Telemed J E Health 2010;16:49–55.
Thijssing L, Van Der Heijen J, Chavannes N, et al. Telepulmonology: Effect on quality and efficiency of care. Respir Med 2014;108:314–318.
Reardon T. Research findings and strategies for assessing telemedicine costs. Telemed J E Health 2005;11:348–368.
Rabinowitz T, Murphy KM, Amour JL, Ricci MA, Caputo MP, Newhouse PA. Benefits of a telepsychiatry consultation service for rural nursing home residents. Telemed J E Health 2010;16:34–40.
Simon GE, VonKorff M, Rutter C, Wagner E. Randomised trial of monitoring, feedback, and management of care by telephone to improve treatment of depression in primary care. BMJ 2000;320:550.
Pyne JM, Fortney JC, Tripathi SP, Maciejewski ML, Edlund MJ, Williams DK. Cost-effectiveness analysis of a rural telemedicine collaborative care intervention for depression. Arch Gen Psychiatry 2010;67:812–821.
Lokkerbol J, Adema D, Cuijpers P, Reynolds CF 3rd, Schulz R, Weehuizen R, Smit F. Improving the cost-effectiveness of a healthcare system for depressive disorders by implementing telemedicine: A health economic modeling study. Am J Geriatr Psychiatry 2014;22:253–262.
Wray LO, Shulan MD, Toseland RW, Freeman KE, Vásquez BE, Gao J. The effect of telephone support groups on costs of care for veterans with dementia. Gerontologist 2010;50:623–631.
Moreno-Ramirez D, Ferrandiz L, Ruiz-de-Casas A, Nieto-Garcia A, Moreno-Alvarez P, Galdeano R, Camacho FM. Economic evaluation of a store-and-forward teledermatology system for skin cancer patients. J Telemed Telecare 2009;15:40–45.
Ferrándiz L, Moreno-Ramírez D, Ruiz-de-Casas A, Nieto-García A, Moreno-Álvarez P, Galdeano R, Camacho FM. An economic analysis of presurgical teledermatology in patients with nonmelanoma skin cancer [in Spanish]. Actas Dermosifiliogr 2008;99:795–802.
Ng MF, Stevenson JH. Diagnostic value and cost-effectiveness of good quality digital images accompanying electronic referrals for suspected skin malignancies. Ann Plast Surg 2011;66:377–380.
van Os‐Medendorp H, Koffijberg H, Eland‐de Kok PCM, van der Zalm A, de Bruin‐Weller MS, Pasmans SGMA, et al. E‐health in caring for patients with atopic dermatitis: A randomized controlled cost‐effectiveness study of internet‐guided monitoring and online self‐management training. Br J Dermatol 2012;166:1060–1068.
Bergmo TS. A cost-minimization analysis of a realtime teledermatology service in northern Norway. J Telemed Telecare 2000;6:273–277.
Armstrong AW, Dorer DJ, Lugn NE, Kvedar JC. Economic evaluation of interactive teledermatology compared with conventional care. Telemed J E Health 2007;13:91–99.
Pak HS, Datta SK, Triplett CA, Lindquist JH, Grambow SC, Whited JD. Cost minimization analysis of a store-and-forward teledermatology consult system. Telemed J E Health 2009;15:160–165.
Pelletier-Fleury N, Gagnadoux F, Philippe C, Rakotonanahary D, Lanoé JL, Fleury B. A cost-minimization study of telemedicine. Int J Technol Assess Health Care 2001;17:604–611.
Harno K, Arajärvi E, Paavola T, Carlson C, Viikinkoski P. Clinical effectiveness and cost analysis of patient referral by videoconferencing in orthopaedics. J Telemed Telecare 2001;7:219–225.
Mark DA, Fitzmaurice GJ, Haughey KA, O'Donnell ME, Harty JC. Assessment of the quality of care and financial impact of a virtual renal clinic compared with the traditional outpatient service model. Int J Clin Pract 2011;65:1100–1107.
Fischer HH, Eisert SL, Everhart RM, Durfee MJ, Moore SL, Soria S, et al. Nurse-run, telephone-based outreach to improve lipids in people with diabetes. Am J Manag Care 2012;18:77–84.
Eakin EG, Reeves MM, Marshall AL, Dunstan DW, Graves N, Healy GN, et al. Living Well with Diabetes: A randomized controlled trial of a telephone-delivered intervention for maintenance of weight loss, physical activity and glycaemic control in adults with type 2 diabetes. BMC Public Health 2010;10:452.
Kesavadev J, Shankar A, Pillai PBS, Krishnan G, Jothydev S. Cost-effective use of telemedicine and self-monitoring of blood glucose via Diabetes Tele Management System (DTMS) to achieve target glycosylated hemoglobin values without serious symptomatic hypoglycemia in 1,000 subjects with type 2 diabetes mellitus—A retrospective study. Diabetes Technol Ther 2012;14:772–776.
Eminović N, Dijkgraaf MG, Berghout RM, Prins AH, Bindels PJ, de Keizer NF. A cost minimisation analysis in teledermatology: Model-based approach. BMC Health Serv Res 2010;10:251.
Salzsieder E, Augstein P. The Karlsburg Diabetes Management System: Translation from research to eHealth application. J Diabetes Sci Technol 2011;5:13–22.
Hitt WC, Low G, Bird TM, Ott R. Telemedical cervical cancer screening to bridge Medicaid service care gap for rural women. Telemed J E Health 2013;19:403–408.
Kimman ML, Dirksen CD, Voogd AC, Falger P, Gijsen BCM, Thuring M, et al. Economic evaluation of four follow-up strategies after curative treatment for breast cancer: Results of an RCT. Eur J Cancer 2011;47:1175–1185.
Thaker DA, Monypenny R, Olver I, Sabesan S. Cost savings from a telemedicine model of care in northern Queensland, Australia. Med J Aust 2013;199:414–417.
Xu CQ, Smith AC, Scuffham PA, Wootton R. A cost minimisation analysis of a telepaediatric otolaryngology service. BMC Health Serv Res 2008;8:30.
Joo NS, Park YW, Park KH, Kim CW, Kim BT. Cost-effectiveness of a community-based obesity control programme. J Telemed Telecare 2010;16:63–67.
Wade VA, Karnon J, Eliott JA, Hiller JE. Home videophones improve direct observation in tuberculosis treatment: A mixed methods evaluation. PLoS One 2012;7:e50155.
Buysse H, De Moor G, Van Maele G, Baert E, Thienpont G, Temmerman M. Cost-effectiveness of telemonitoring for high-risk pregnant women. Int J Med Inform 2008;77:470–476.
Lilly CM, McLaughlin JM, Zhao H, Baker SP, Cody S, Irwin RS. A multicenter study of ICU telemedicine reengineering of adult critical care. Chest 2014;145:500–507.
Isetta V, Lopez-Agustina C, Lopez-Bernal E, Amat M, Vila M, Valls C, et al. Cost-effectiveness of a new internet-based monitoring tool for neonatal post-discharge home care. J Med Internet Res 2013;15:e38.
Henderson C, Knapp M, Fernandez JL, et al. Cost effectiveness of telehealth for patients with long term conditions (Whole System Demonstrator telehealth questionnaire study): Nested economic evaluation in a pragmatic, cluster randomized control trial. BMJ 2013;346:1–19.
Andrade M, Maia A, Cardoso C, et al. Cost-benefit of the telecardiology service in the state of Minas Gerais: Minas Telecardio Project [in English, Portuguese]. Arq Bras Cardiol 2011;97:307–316.
Alkmim M, Figueira R, Marcolino M. Improving patient access to specialized health care: The telehealth network of Minas Gerais, Brazil. Bull World Health Organ 2012;90:373–378.
Sohn S, Helms TM, Pelleter JT, et al. Costs and benefits of personalized healthcare for patients with chronic heart failure in the care and education program “Telemedicine for the Heart.” Telemed J E Health 2012;18:198–204.
Smith B, Hughes-Cromwick P, Forkner E, et al. Cost-effectiveness of telephonic disease management in heart failure. Am J Manag Care 2008;14:106–115.
Elliot R, Barber N, Clifford S, et al. The cost effectiveness of a telephone-based pharmacy advisory service to improve adherence to newly prescribed medicines. Pharm World Sci 2008;30:17–23.
Salvador C, Ruiz-Sanchez A, Gonzalez de Mingo M, et al. Evaluation of a telemedicine-based service for the follow-up and monitoring of patients treated with oral anticoagulant therapy. IEEE Trans Inf Technol Biomed 2008;12:696–706.
Datta S, Oddone E, Olsen M, et al. Economic analysis of a tailored behavioral intervention to improve blood pressure control for primary care patients. Am Heart J 2010;160:257–263.
Wennberg DE, Marr A, Lang L, O'Malley S, Bennett G. A randomized trial of a telephone care-management strategy. N Engl J Med 2010;363:1245–1255.
Minetaki K, Akematsu Y, Tsuji M. Effect of e-health on medical expenditures of outpatients with lifestyle-related diseases. Telemed J E Health 2011;17:591–595.
Brunetti N, Dellegrottaglie G, Lapriore C, et al. Prehospital telemedicine electrocardiogram triage for a regional public emergency medical service: Is it worth it? A preliminary cost analysis. Clin Cardiol 2014;37:140–145.
Calo L, Gargao A, De Ruvo E, et al. Economic impact of remote monitoring on ordinary follow-up of implantable cardioverter defibrillators as compared with conventional in-hospital visits. A single center prospective randomized study. J Interv Card Electrophysiol 2013;37:69–78.
Zanaboni P, Landolina M, Marzegalli, et al. Cost-utility analysis of the EVOLVO study on remote monitoring for heart failure patients with implantable defibrillators: Randomized controlled trial. J Med Internet Res 2013;15:e106.
Chen YH, Lin YH, Hung CS, et al. Clinical outcomes and cost-effectiveness of a synchronous telehealth service for seniors and nonseniors with cardiovascular diseases: Quasi-experimental study. J Med Internet Res 2013;15:e87.
Coleman EA, Parry C, Chalmers S, et al. The care transitions intervention: Results of a randomized controlled trial. Arch Intern Med 2006;166:1822–1828.
Chugh A, Williams MV, Grigsby J, et al. Better transitions: Improving comprehension of discharge instructions. Front Health Serv Manage 2009;25:11–32.

Information & Authors


Published In

cover image Telemedicine and e-Health
Telemedicine and e-Health
Volume 20Issue Number 9September 2014
Pages: 769 - 800
PubMed: 24968105


Published online: 3 September 2014
Published in print: September 2014
Published ahead of print: 26 June 2014
Accepted: 28 May 2014
Received: 28 May 2014


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Rashid L. Bashshur
E-Health Center, University of Michigan Health System, Ann Arbor, Michigan.
Gary W. Shannon
Department of Geography, University of Kentucky, Lexington, Kentucky.
Brian R. Smith
E-Health Center, University of Michigan Health System, Ann Arbor, Michigan.
Dale C. Alverson
University of New Mexico, Albuquerque, New Mexico.
Nina Antoniotti
Marshfield Clinic, Marshfield, Wisconsin.
William G. Barsan
University of Michigan Health System, Ann Arbor, Michigan.
Noura Bashshur
E-Health Center, University of Michigan Health System, Ann Arbor, Michigan.
Edward M. Brown
Ontario Telemedicine Network, Toronto, Ontario, Canada.
Molly J. Coye
University of California at Los Angeles, Los Angeles, California.
Charles R. Doarn
Family and Community Medicine, University of Cincinnati, Cincinnati, Ohio.
Stewart Ferguson
Alaska Native Tribal Health Consortium, Anchorage, Alaska.
Jim Grigsby
University of Colorado Denver, Denver, Colorado.
Elizabeth A. Krupinski
University of Arizona, Tucson, Arizona.
Joseph C. Kvedar
Partners Health Care, Harvard University, Cambridge, Massachusetts.
Jonathan Linkous
American Telemedicine Association, Washington, D.C.
Ronald C. Merrell
Virginia Commonwealth University, Richmond, Virginia.
Thomas Nesbitt
University of California Davis, Sacramento, California.
Ronald Poropatich
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Karen S. Rheuban
University of Virginia, Charlottesville, Virginia.
Jay H. Sanders
The Global Telemedicine Group, McLean, Virginia.
Andrew R. Watson
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Ronald S. Weinstein
University of Arizona, Tucson, Arizona.
Peter Yellowlees
University of California Davis, Sacramento, California.


Address correspondence to:Rashid L. Bashshur, PhDSenior Advisor for e-HealthUniversity of Michigan Health System300 North Ingalls, SPC 5402Ann Arbor, MI 48109-5402E-mail: [email protected]

Disclosure Statement

J.S. is an employee of The Global Telemedicine Group. No competing financial interests exist for any of the other authors.

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