Key research papers on telehealth and telemedicine

How the literature is organised

Before 2020, telehealth research was organised around three questions. Does it work? Ekeland, Bowes and Flottorp (2010) is the systematic review of reviews from that era. Will clinicians and patients use it? Hu et al. (1999) tested the technology acceptance model on physicians in Hong Kong public hospitals and found perceived usefulness a significant determinant of intention while perceived ease of use was not — a result worth knowing before you build a survey around both. Kruse et al. (2018) reviewed 30 articles and counted 33 distinct barriers to adoption worldwide, led by technically challenged staff (11%), resistance to change (8%) and cost (8%). Kruse et al. (2017) screened 2,193 articles for patient satisfaction and found improved outcomes, preference for the modality, ease of use, low cost, better communication and less travel time accounting for 61% of the factors mentioned. Where is it going? Dorsey and Topol (2016) describe telehealth evolving from the clinic to the home.

The pandemic turned a specialist topic into a mainstream one. Hollander and Carr (2020), Smith et al. (2020) and Wosik et al. (2020) argued the case as it happened; Mann et al. (2020) supplied the numbers from one New York health system, where daily telemedicine urgent care visits went from 102.4 to 801.6 between early March and mid-April 2020. Monaghesh and Hajizadeh (2020) reviewed the early evidence and found just eight studies meeting their criteria, which is worth remembering when that review is cited as though it settled something.

Main debates

The main argument since 2021 has been about equity, and the listed studies make it concrete. Rodriguez et al. (2021), across 231,596 visits at one integrated health system, found patients over 65, Black, Hispanic, Spanish-speaking or in low-broadband areas significantly less likely to have a video rather than a telephone visit — and found that practices (38%) and clinicians (26%) drove far more of the variation in video use than patients did (9%). Chang et al. (2021) found the same split on the provider side in New York City: small primary care practices in high social vulnerability areas were nearly twice as likely to use the telephone as their main modality, and about half as likely to use video, as those in low-vulnerability areas. Patel et al. (2021), across 16.7 million enrollees, found telemedicine accounting for 30.1% of visits during the pandemic, lower in communities with higher poverty rates, and ranging from 68% of endocrinologists to 9% of ophthalmologists.

A second debate concerns payment and regulation after emergency rules expire. Shaver (2022) covers the US position; the OECD (2023) reports that the boom preserved access and continuity of care but also exposed the limits of remote care and raised concerns that some teleconsultations are low-value.

Where recent work is heading

Work has shifted from "can we?" to "when should we?". Snoswell et al. (2023) consolidate clinical effectiveness and note how discipline-specific the evidence is. Butzner and Cuffee (2021) review 15 studies of rural US communities and report acceptability, lower costs and better recruitment and retention of clinicians. Barbosa et al. (2021) conclude that telemedicine has improved access across a wide range of conditions and has addressed geographical barriers, but less so social ones. Omboni et al. (2022) list what large-scale implementation still needs: legislation, licensing, privacy protection, reimbursement plans, practical clinical guidelines and integration with conventional services. Bitar and Alismail (2021) make the honest point about the pandemic literature — limited evidence on effectiveness.

Newer angles include environmental impact: Purohit, Smith and Hibble (2021) found every identified study reporting a reduced carbon footprint, mostly from avoided travel, with savings ranging from 0.70 to 372 kg CO2e per consultation and highly context-specific. For nursing students, competencies for telehealth practice and patient experience are tractable thesis topics.