Appl Clin Inform 2010; 01(02): 132-141
DOI: 10.4338/ACI-2009-12-R-0020
Review
Schattauer GmbH

Telemedicine

What have we learned?
P. Whitten
1   Michigan State University
,
B. Holtz
1   Michigan State University
,
C. LaPlante
1   Michigan State University
› Author Affiliations
Further Information

Correspondence to:

Pamela Whitten, PhD
Dean
College of Communication Arts & Sciences
East Lansing, MI 48824-1212

Publication History

Received 04 December 2009

Accepted 15 April 2010

Publication Date:
20 December 2017 (online)

 

Summary

As the health care industry is facing many challenges and is undergoing extensive change, telemedicine is in the position to address these challenges and be an important part of health care’s development. Telemedicine has been used for approximately a half century, in which researchers have explored the different technologies utilized, clinical outcomes, cost benefits, perceptions, and adoption challenges of its use. This paper reviews and summarizes these findings and presents possible future research endeavors. Examining what is known about telemedicine can aid in the development of innovative, sustainable and beneficial health technologies that could positively impact health care delivery and outcomes.

Citation: Whitten P, Holz B, LaPlante C. Telemedicine – what have we learned? Appl Clin Inf 2010; 1: 132–141 http://dx.doi.org/10.4338/ACI-2009-12-R-0020


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Conflict of Interest Statement

The authors declare that they have no conflict of interest related to this manuscript. They also state that there is no financial conflict of interest related to this manuscript.

  • References

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  • 2 Whitten P, Goolittle G, Hellmich S. Telehospice: Using telecommunication technology for terminally ill patients. JCMC. [Internet]. 2001 Jul [cited 2010 Feb 6]; 6(4). Available from http://jcmc.indiana.edu/vol6/issue4/whitten2.html
  • 3 Grigsby J. Telemedicine: Where it is and where it’s going. Annals of Internal Medicine 1998; 129 (Suppl. 02) 123-127.
  • 4 Craig J, Patterson V. Introduction to the practice of telemedicine. Journal of Telemedicine and Telecare 2005; 11: 3-9.
  • 5 McLendon K. E-commerce and HIM: Ready or not, here it comes. Journal of the American Health Information Management Association 2000; 71 (Suppl. 01) 22-23.
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  • 8 Heath B, Salerno R, Hopkins A. et al. Telemedicine for pediatric critical care consultation. Pediatr Crit Care Med 2009 10. 05 Epub 2009 May 15; doi:10.1097/PCC.0b013e3181a63eac.
  • 9 Levine SR, Forman M. “Telestroke”: The application of telemedicine for stroke. Stroke 1999; 30: 464-469.
  • 10 Whitten P, Buis L. Use of telemedicine for haemodialysis: perceptions of patients and healthcare providers, and clinical effects. J Telemed Telecare 2008; 14: 75-78.
  • 11 Burdick AE. Teledermatology: Extending specialty care beyond borders. Archives of Dermatology 2007; 143 (Suppl. 12) 1581-1582.
  • 12 Pare G, Jaana M, Sicotte C. Systematic review of home telemonitoring for chronic diseases: The evidence base. Journal of the American Medical Informatics Association 2007; 14 (Suppl. 03) 269-277.
  • 13 Steinbrook R. The age of teleradiology. The New England Journal of Medicine 2007; 357: 5-7.
  • 14 Field MJ, Grigsby J. Telemedicine and remote patient monitoring. JAMA 2002; 288: 423-425.
  • 15 Crossley G, Boyle A, Vitense H, Sherfesse L, Hardwin Mead R. Trial design of the clinical evaluation of remote notification to reduce time to clinical decision: The clinical evaluation of remote notification to reduce time to clinical decision (CONNECT) study. American Heart Journal 2008; 156 (Suppl. 05) 840-846.
  • 16 Whitten P, Bergman A, Meese MA, Bridwell K, Jule K. St. Vincent’s home telehealth for congestive heart failure patients. Telemedicine and e-Health 2009; 15 (Suppl. 02) 148-153.
  • 17 Whitten P, Mickus M. Home telecare for COPD/CHF patients: Outcomes and perceptions. Journal of Telemedicine and Telecare 2007; 13: 69-73.
  • 18 Holtz B, Whitten P. Managing asthma with mobile phones: A feasibility study. Telemedicine and e-Health 2009; 15: 907-909.
  • 19 Harasanyi G. Sensors in biomedical application: May they change the quality of life. Sensor Review 2001; 21 (Suppl. 04) 259-267.
  • 20 Topol EJ. The new healthcare: Smart band aids, digital pills, wrist bands. 2009 Sept 30 [cited 2009 Nov 21]; Venture Beat. Available from: http://venturebeat.com/2009/09/20/the-new-healthcare-smart-band-aids-digital-pills-wrist-bands-promise-to-track-your-health
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  • 26 D’Souza R. Telemedicine for intensive support of psychiatric inpatients admitted to local hospitals. J Telemed Telecare 2000; 6 Suppl. 1 26-28.
  • 27 Durani H, Khoja S. A systematic review of the use of telehealth in Asian countries. Journal of Telemedicine and Telecare 2009; 15: 175-181.
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  • 30 Nelson EL, Barnard M, Cain S. Feasibility of telemedicine intervention for childhood depression. Counselling and Psychotherapy Research. 2006; 6 (Suppl. 03) 191-195.
  • 31 Rasmusson KA, Hartshorn JC. A comparison of epilepsy patients in a traditional ambulatory clinic and a telemedicine clinic. Epilepsia 2005; 46 (Suppl. 05) 767-770.
  • 32 Benger JR, Noble SM, Coast J, Kendall JM. The safety and effectiveness of minor injuries telemedicine. Emerg Med J 2004; 21 (Suppl. 04) 438-445.
  • 33 Jenkins RL, McSweeney M. Assessing elderly patients with congestive heart failure via in-home interactive telecommunication. J Gerontol Nurs 2001; 27: 21-27
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  • 35 Kairy D, Lehoux P, Vincent C, Visintin M. A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation. Disabil Rehabil 2009; 31 (Suppl. 06) 427-447.
  • 36 Rojas SV, Gagnon MP. A systematic review of the key indicators for assessing telehomecare cost-effectiveness. Telemed J E Health 2008; 14 (Suppl. 09) 896-904.
  • 37 Whitten P, Mair F, Hatcox A, May C, Williams T, Hellmich S. Systematic review of cost-effectiveness: Studies of telemedicine interventions. BMJ 2002; 324: 1434-1437.
  • 38 Jennett PA, Scott RE, Affleck Hall L, Hailey D, Ohinmaa A, Anderson C. et al. Policy implications associated with the socioeconomic and health system impact of telehealth: A case study from Canada. Telemed J E Health 2004; 10 (Suppl. 01) 77-83.
  • 39 Myers KM, Valentine JM, Melzer SM. Child and adolescent telepsychiatry: utilization and satisfaction. Telemed J E Health 2008; 14 (Suppl. 02) 131-137.
  • 40 Favero L, Pavan L, Arreghini A. Communication through telemedicine: home teleassistance in orthodontics. Eur J Paediatr Dent 2009; 10 (Suppl. 04) 163-167.
  • 41 Heaney D, Caldow J, McClusky C, King G, Webster K, Mair F. et al. The introduction of a new consulting technology into the National Health Service (NHS) for Scotland. Telemed J E Health 2009; 15 (Suppl. 06) 546-551.
  • 42 Cho JH, Lee HC, Lim DJ, Kwon HS, Yoon KH. Mobile communication using a mobile phone with a glucometer for glucose control in Type 2 patients with diabetes: as effective as an Internet-based glucose monitoring system. J Telemed Telecare 2009; 15 (Suppl. 02) 77-82.
  • 43 Mishra A, Kapoor L, Mishra SK. Post-operative care through tele-follow up visits in patients undergoing thyroidectomy and parathyroidectomy in a resource-constrained environment. J Telemed Telecare 2009; 15 (Suppl. 02) 73-76.
  • 44 Lemmetty R, Mäkelä K. Mobile digital fundus screening of type 2 diabetes patients in the Finnish county of South-Ostrobothnia. J Telemed Telecare 2009; 15 (Suppl. 02) 68-72.
  • 45 Varkey P, Schumacher K, Swanton C, Timm B, Hagen PT. Telemedicine in the work site: a study of feasibility, and patient and provider satisfaction. J Telemed Telecare 2008; 14 (Suppl. 06) 322-325.
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  • 47 Duke C. The Frail Elderly Community-Based Case Management Project. Geriatr Nurs 2005; 26 (Suppl. 02) 122-127.
  • 48 Smith GE, Lunde AM, Hathaway JC, Vickers KS. Telehealth home monitoring of solitary persons with mild dementia. Am J Alzheimers Dis Other Demen 2007; 22: 20-26.
  • 49 Whitten PS, Mackert MS. Addressing telehealth’s foremost barrier: provider as initial gatekeeper. Int J Technol Assess Health Care 2005; 21 (Suppl. 04) 517-521.
  • 50 Moreno D, Ferrándiz L, Pérez-Bernal AM, Ríos JJ, Carrasco R, Camacho F. Evaluation of a screening system for patients with pigmented lesions using store-and-forward teleconsultation. Actas Dermosifiliogr 2005; 96 (Suppl. 04) 222-230.
  • 51 Al-Kadi A, Dyer D, Ball CG, McBeth PB, Hall R, Lan S. et al. User’s perceptions of remote trauma telesonography. J Telemed Telecare 2009; 15 (Suppl. 05) 251-254.
  • 52 Whitten P, Buis L, Love B. Physician-patient e-visit programs: Implementation and appropriateness. Disease Management & Health Outcomes 2007; 15 (Suppl. 04) 207-214.
  • 53 Mair FS, Goldstein P, May C, Angus R, Shiels C, Hibbert D. et al. Patient and provider perspectives on home telecare: preliminary results from a randomized controlled trial. J Telemed Telecare 2005; 11 (Suppl. 01) 95-97.
  • 54 Collins K, Bowns I, Walters S. General practitioners’ perceptions of asynchronous telemedicine in a randomized controlled trial of teledermatology. J Telemed Telecare 2004; 10 (Suppl. 02) 94-98.
  • 55 Wang Z, Gu H. A review of telemedicine in China. J Telemed Telecare 2009; 15 (Suppl. 01) 23-27.
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  • 57 Mair F, Finch T, May C, Hiscock J, Beaton S, Goldstein P. et al. Perceptions of risk as a barrier to the use of telemedicine. J Telemed Telecare 2007; 13 (Suppl. 01) 38-39.
  • 58 Cloutier P, Cappelli M, Glennie JE, Keresztes C. Mental health services for children and youth: a survey of physicians’ knowledge, attitudes and use of telehealth services. J Telemed Telecare 2008; 14 (Suppl. 02) 98-101.
  • 59 Whitten P, Holtz B. Provider utilization of telemedicine: the elephant in the room. Telemed J E Health. 2008; 14 (Suppl. 09) 995-997.
  • 60 Whitten P, Buis L. Private payer reimbursement for telemedicine services in the United States. Telemed J E Health 2007; 13 (Suppl. 01) 15-23.
  • 61 Dyb K, Halford S. Placing globalization technologies: Telemedicine and the making of difference. Sociology 2009; 43: 232-249.
  • 62 de Bustos EM, Moulin T, Audebert HJ. Barriers, legal issues, limitations and ongoing questions in telemedicine applied to stroke. Cerebrovasc Dis 2009; 27 (Suppl. 04) 36-39.
  • 63 Schmeida M, McNeal R, Mossberger K. Policy determinants affect telehealth implementation. Telemed J E Health 2007; 13 (Suppl. 02) 100-107.
  • 64 Smith AC. Telemedicine: challenges and opportunities. Expert Rev Med Devices 2007; 4 (Suppl. 01) 5-7.
  • 65 Whitten P, Holtz B, Young R, Davis S. The organizational structure and architecture of telemedicine: Keys to success. Paper presented at the 2009 American Telemedicine Association Conference. 2009 April; Las Vegas, Nevada.:
  • 66 Whitten P, Holtz B, Nguyen L. Keys to a Successful and Sustainable Telemedicine Program. International Journal of Technology Assessment in Health Care. Forthcoming 2010
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Correspondence to:

Pamela Whitten, PhD
Dean
College of Communication Arts & Sciences
East Lansing, MI 48824-1212

  • References

  • 1 Wittson CL, Affleck DC, Johnson V. Two-way television in group therapy. Mental Hospitals. 1961; 12 (Suppl. 10) 22-23.
  • 2 Whitten P, Goolittle G, Hellmich S. Telehospice: Using telecommunication technology for terminally ill patients. JCMC. [Internet]. 2001 Jul [cited 2010 Feb 6]; 6(4). Available from http://jcmc.indiana.edu/vol6/issue4/whitten2.html
  • 3 Grigsby J. Telemedicine: Where it is and where it’s going. Annals of Internal Medicine 1998; 129 (Suppl. 02) 123-127.
  • 4 Craig J, Patterson V. Introduction to the practice of telemedicine. Journal of Telemedicine and Telecare 2005; 11: 3-9.
  • 5 McLendon K. E-commerce and HIM: Ready or not, here it comes. Journal of the American Health Information Management Association 2000; 71 (Suppl. 01) 22-23.
  • 6 Maheu MM, Whitten P, Allen A. editors. E-health, telehealth, and telemedicine: A guide to start-up and success. Jossey-Bass; 2001
  • 7 Hilty DM, Yellowles PM, Cobb HC, Bourgeois JA, Nuefeld JD, Nesbitt TS. Models of telepsychiatric consultation –Liaison service to rural primary care. Psychosomatics 2006; 47: 152-157.
  • 8 Heath B, Salerno R, Hopkins A. et al. Telemedicine for pediatric critical care consultation. Pediatr Crit Care Med 2009 10. 05 Epub 2009 May 15; doi:10.1097/PCC.0b013e3181a63eac.
  • 9 Levine SR, Forman M. “Telestroke”: The application of telemedicine for stroke. Stroke 1999; 30: 464-469.
  • 10 Whitten P, Buis L. Use of telemedicine for haemodialysis: perceptions of patients and healthcare providers, and clinical effects. J Telemed Telecare 2008; 14: 75-78.
  • 11 Burdick AE. Teledermatology: Extending specialty care beyond borders. Archives of Dermatology 2007; 143 (Suppl. 12) 1581-1582.
  • 12 Pare G, Jaana M, Sicotte C. Systematic review of home telemonitoring for chronic diseases: The evidence base. Journal of the American Medical Informatics Association 2007; 14 (Suppl. 03) 269-277.
  • 13 Steinbrook R. The age of teleradiology. The New England Journal of Medicine 2007; 357: 5-7.
  • 14 Field MJ, Grigsby J. Telemedicine and remote patient monitoring. JAMA 2002; 288: 423-425.
  • 15 Crossley G, Boyle A, Vitense H, Sherfesse L, Hardwin Mead R. Trial design of the clinical evaluation of remote notification to reduce time to clinical decision: The clinical evaluation of remote notification to reduce time to clinical decision (CONNECT) study. American Heart Journal 2008; 156 (Suppl. 05) 840-846.
  • 16 Whitten P, Bergman A, Meese MA, Bridwell K, Jule K. St. Vincent’s home telehealth for congestive heart failure patients. Telemedicine and e-Health 2009; 15 (Suppl. 02) 148-153.
  • 17 Whitten P, Mickus M. Home telecare for COPD/CHF patients: Outcomes and perceptions. Journal of Telemedicine and Telecare 2007; 13: 69-73.
  • 18 Holtz B, Whitten P. Managing asthma with mobile phones: A feasibility study. Telemedicine and e-Health 2009; 15: 907-909.
  • 19 Harasanyi G. Sensors in biomedical application: May they change the quality of life. Sensor Review 2001; 21 (Suppl. 04) 259-267.
  • 20 Topol EJ. The new healthcare: Smart band aids, digital pills, wrist bands. 2009 Sept 30 [cited 2009 Nov 21]; Venture Beat. Available from: http://venturebeat.com/2009/09/20/the-new-healthcare-smart-band-aids-digital-pills-wrist-bands-promise-to-track-your-health
  • 21 Sriram J, Kotz D, Rahan A, Sastry M, Yarvis M. Challenges in data quality assurance in pervasive health monitoring systems. Paper presented at the Future of Trust In Computing conference; June/July 2008; Berlin, Germany.:
  • 22 Whitten P, Mylod D, Gavran G, Sypher H. “Most Wired Hospitals” rate patient satisfaction. Communications of the ACM 2008; 51 (Suppl. 04) 96-102.
  • 23 Håkansson S, Gaveline C. What do we really know about the cost effectiveness of telemedicine. Journal of Telemedicine and Telecare 2000; 6 Suppl. 1 133-136.
  • 24 DelliFraine JL, Dansky KH. Home-based telehealth: A review and meta-analysis. J Telemed Telecare 2008; 14 (Suppl. 02) 62-66.
  • 25 Hailey D, Roine R, Ohinmaa A. The effectiveness of telemental health applications: A review. Can J Psychiatry 2008; 53 (Suppl. 11) 769-778.
  • 26 D’Souza R. Telemedicine for intensive support of psychiatric inpatients admitted to local hospitals. J Telemed Telecare 2000; 6 Suppl. 1 26-28.
  • 27 Durani H, Khoja S. A systematic review of the use of telehealth in Asian countries. Journal of Telemedicine and Telecare 2009; 15: 175-181.
  • 28 Lovell K, Cox D, Haddock G, Jones CE, Raines D, Garvey R. et al. Telephone administered cognitive behaviour therapy for treatment of obsessive compulsive disorder: randomised controlled non-inferiority trial. BMJ 2006; 333 7574 883.
  • 29 De Las Cuevas C, Arredondo MT, Cabrera MF, Sulzenbacher H, Meise U. Randomized clinical trial of telepsychiatry through videoconference versus face-to-face conventional psychiatric treatment. Telemed J E Health 2006; 12 (Suppl. 03) 341-50.
  • 30 Nelson EL, Barnard M, Cain S. Feasibility of telemedicine intervention for childhood depression. Counselling and Psychotherapy Research. 2006; 6 (Suppl. 03) 191-195.
  • 31 Rasmusson KA, Hartshorn JC. A comparison of epilepsy patients in a traditional ambulatory clinic and a telemedicine clinic. Epilepsia 2005; 46 (Suppl. 05) 767-770.
  • 32 Benger JR, Noble SM, Coast J, Kendall JM. The safety and effectiveness of minor injuries telemedicine. Emerg Med J 2004; 21 (Suppl. 04) 438-445.
  • 33 Jenkins RL, McSweeney M. Assessing elderly patients with congestive heart failure via in-home interactive telecommunication. J Gerontol Nurs 2001; 27: 21-27
  • 34 Davalos ME, French MT, Burdick AE, Simmons SC. Economic evaluation of telemedicine: Review of the literature and research guidelines for benefit-cost analysis. Telemed J E Health 2009; 15 (Suppl. 02) 933-948.
  • 35 Kairy D, Lehoux P, Vincent C, Visintin M. A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation. Disabil Rehabil 2009; 31 (Suppl. 06) 427-447.
  • 36 Rojas SV, Gagnon MP. A systematic review of the key indicators for assessing telehomecare cost-effectiveness. Telemed J E Health 2008; 14 (Suppl. 09) 896-904.
  • 37 Whitten P, Mair F, Hatcox A, May C, Williams T, Hellmich S. Systematic review of cost-effectiveness: Studies of telemedicine interventions. BMJ 2002; 324: 1434-1437.
  • 38 Jennett PA, Scott RE, Affleck Hall L, Hailey D, Ohinmaa A, Anderson C. et al. Policy implications associated with the socioeconomic and health system impact of telehealth: A case study from Canada. Telemed J E Health 2004; 10 (Suppl. 01) 77-83.
  • 39 Myers KM, Valentine JM, Melzer SM. Child and adolescent telepsychiatry: utilization and satisfaction. Telemed J E Health 2008; 14 (Suppl. 02) 131-137.
  • 40 Favero L, Pavan L, Arreghini A. Communication through telemedicine: home teleassistance in orthodontics. Eur J Paediatr Dent 2009; 10 (Suppl. 04) 163-167.
  • 41 Heaney D, Caldow J, McClusky C, King G, Webster K, Mair F. et al. The introduction of a new consulting technology into the National Health Service (NHS) for Scotland. Telemed J E Health 2009; 15 (Suppl. 06) 546-551.
  • 42 Cho JH, Lee HC, Lim DJ, Kwon HS, Yoon KH. Mobile communication using a mobile phone with a glucometer for glucose control in Type 2 patients with diabetes: as effective as an Internet-based glucose monitoring system. J Telemed Telecare 2009; 15 (Suppl. 02) 77-82.
  • 43 Mishra A, Kapoor L, Mishra SK. Post-operative care through tele-follow up visits in patients undergoing thyroidectomy and parathyroidectomy in a resource-constrained environment. J Telemed Telecare 2009; 15 (Suppl. 02) 73-76.
  • 44 Lemmetty R, Mäkelä K. Mobile digital fundus screening of type 2 diabetes patients in the Finnish county of South-Ostrobothnia. J Telemed Telecare 2009; 15 (Suppl. 02) 68-72.
  • 45 Varkey P, Schumacher K, Swanton C, Timm B, Hagen PT. Telemedicine in the work site: a study of feasibility, and patient and provider satisfaction. J Telemed Telecare 2008; 14 (Suppl. 06) 322-325.
  • 46 Paul PG, Raman R, Rani PK, Deshmukh H, Sharma T. Patient satisfaction levels during teleophthalmology consultation in rural South India. Telemed J E Health 2006; 12 (Suppl. 05) 571-578.
  • 47 Duke C. The Frail Elderly Community-Based Case Management Project. Geriatr Nurs 2005; 26 (Suppl. 02) 122-127.
  • 48 Smith GE, Lunde AM, Hathaway JC, Vickers KS. Telehealth home monitoring of solitary persons with mild dementia. Am J Alzheimers Dis Other Demen 2007; 22: 20-26.
  • 49 Whitten PS, Mackert MS. Addressing telehealth’s foremost barrier: provider as initial gatekeeper. Int J Technol Assess Health Care 2005; 21 (Suppl. 04) 517-521.
  • 50 Moreno D, Ferrándiz L, Pérez-Bernal AM, Ríos JJ, Carrasco R, Camacho F. Evaluation of a screening system for patients with pigmented lesions using store-and-forward teleconsultation. Actas Dermosifiliogr 2005; 96 (Suppl. 04) 222-230.
  • 51 Al-Kadi A, Dyer D, Ball CG, McBeth PB, Hall R, Lan S. et al. User’s perceptions of remote trauma telesonography. J Telemed Telecare 2009; 15 (Suppl. 05) 251-254.
  • 52 Whitten P, Buis L, Love B. Physician-patient e-visit programs: Implementation and appropriateness. Disease Management & Health Outcomes 2007; 15 (Suppl. 04) 207-214.
  • 53 Mair FS, Goldstein P, May C, Angus R, Shiels C, Hibbert D. et al. Patient and provider perspectives on home telecare: preliminary results from a randomized controlled trial. J Telemed Telecare 2005; 11 (Suppl. 01) 95-97.
  • 54 Collins K, Bowns I, Walters S. General practitioners’ perceptions of asynchronous telemedicine in a randomized controlled trial of teledermatology. J Telemed Telecare 2004; 10 (Suppl. 02) 94-98.
  • 55 Wang Z, Gu H. A review of telemedicine in China. J Telemed Telecare 2009; 15 (Suppl. 01) 23-27.
  • 56 Kerr K, Norris T. Telehealth in New Zealand: current practice and future prospects. J Telemed Telecare. 2004; 10 (Suppl. 01) 60-63.
  • 57 Mair F, Finch T, May C, Hiscock J, Beaton S, Goldstein P. et al. Perceptions of risk as a barrier to the use of telemedicine. J Telemed Telecare 2007; 13 (Suppl. 01) 38-39.
  • 58 Cloutier P, Cappelli M, Glennie JE, Keresztes C. Mental health services for children and youth: a survey of physicians’ knowledge, attitudes and use of telehealth services. J Telemed Telecare 2008; 14 (Suppl. 02) 98-101.
  • 59 Whitten P, Holtz B. Provider utilization of telemedicine: the elephant in the room. Telemed J E Health. 2008; 14 (Suppl. 09) 995-997.
  • 60 Whitten P, Buis L. Private payer reimbursement for telemedicine services in the United States. Telemed J E Health 2007; 13 (Suppl. 01) 15-23.
  • 61 Dyb K, Halford S. Placing globalization technologies: Telemedicine and the making of difference. Sociology 2009; 43: 232-249.
  • 62 de Bustos EM, Moulin T, Audebert HJ. Barriers, legal issues, limitations and ongoing questions in telemedicine applied to stroke. Cerebrovasc Dis 2009; 27 (Suppl. 04) 36-39.
  • 63 Schmeida M, McNeal R, Mossberger K. Policy determinants affect telehealth implementation. Telemed J E Health 2007; 13 (Suppl. 02) 100-107.
  • 64 Smith AC. Telemedicine: challenges and opportunities. Expert Rev Med Devices 2007; 4 (Suppl. 01) 5-7.
  • 65 Whitten P, Holtz B, Young R, Davis S. The organizational structure and architecture of telemedicine: Keys to success. Paper presented at the 2009 American Telemedicine Association Conference. 2009 April; Las Vegas, Nevada.:
  • 66 Whitten P, Holtz B, Nguyen L. Keys to a Successful and Sustainable Telemedicine Program. International Journal of Technology Assessment in Health Care. Forthcoming 2010
  • 67 Krishna S, Boren SA, Balas EA. Healthcare via cell phones: a systematic review. Telemed J E Health 2009; 15 (Suppl. 03) 231-240.
  • 68 Ferrer-Roca O, Cardenas A, Diaz-Cardama A, Pulido P. Mobile phone text messaging in the management of diabetes. J Telemed Telecare 2004; 10 (Suppl. 05) 282-286.
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