title: Effectiveness of telemedicine: a systematic review of reviews.
abstract: OBJECTIVE
  To conduct a review of reviews on the impacts and costs of telemedicine services.
  
  
  METHODS
  A review of systematic reviews of telemedicine interventions was conducted. Interventions included all e-health interventions, information and communication technologies for communication in health care, Internet based interventions for diagnosis and treatments, and social care if important part of health care and in collaboration with health care for patients with chronic conditions were considered relevant. Each potentially relevant systematic review was assessed in full text by one member of an external expert team, using a revised check list from EPOC (Cochrane Effective Practice and Organisation of Care Group) to assess quality. Qualitative analysis of the included reviews was informed by principles of realist review.
  
  
  RESULTS
  In total 1593 titles/abstracts were identified. Following quality assessment, the review included 80 heterogeneous systematic reviews. Twenty-one reviews concluded that telemedicine is effective, 18 found that evidence is promising but incomplete and others that evidence is limited and inconsistent. Emerging themes are the particularly problematic nature of economic analyses of telemedicine, the benefits of telemedicine for patients, and telemedicine as complex and ongoing collaborative achievements in unpredictable processes.
  
  
  CONCLUSIONS
  The emergence of new topic areas in this dynamic field is notable and reviewers are starting to explore new questions beyond those of clinical and cost-effectiveness. Reviewers point to a continuing need for larger studies of telemedicine as controlled interventions, and more focus on patients' perspectives, economic analyses and on telemedicine innovations as complex processes and ongoing collaborative achievements. Formative assessments are emerging as an area of interest.
authors.affiliation: Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, P.O. Box 6060, N-9038 Tromsø, Norway. anne.granstrom.ekeland@telemed.no
authors.forename: Anne G
authors.initials: AG
authors.lastname: Ekeland
authors.forename: Alison
authors.initials: A
authors.lastname: Bowes
authors.forename: Signe
authors.initials: S
authors.lastname: Flottorp
mesh_terms: D003362:Cost-Benefit Analysis; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D017063:Outcome Assessment, Health Care; D011050:Policy Making; D019035:Rural Health Services; D017216:Telemedicine / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States