Worldwide implementation of telemedicine programs in association with research performance and health policy

Abstract

We analyzed research performance, international collaboration, corporate contribution, country level economic factors, and legislative frameworks in association with worldwide implementation of telemedicine programs. Methods: We identified telemedicine scholarly output in EMBASE and SCOPUS and SciVal and combine with Third Global Survey on eHealth available in the World Health Organization Global Observatory for eHealth. Results: From 71245 telemedicine-related publications only 0.8% addressed a policy of tele-healthcare delivery. Scholarly output was positively associated with implementation of telemedicine, with legal framework supporting utilization of telemedicine and with country income and total health expenditure but not total population, physician, nurses or hospital bed density or life expectance. National eHealth policy, capacity building (training of medical students and staff), legislative regulations of electronic health records, and supply chain management information systems supported by information and communication technologies were associated with implementation of all examined telemedicine programs. 43 telecommunication technology or medical devices manufacturing companies contributed to more than 90% of scholarly output and implementation of telemedicine. Conclusions: Research performance, training of medical students and healthcare professionals and collaboration with technology industry demonstrated the strongest association with implementation of telemedicine. Future efforts should be directed toward consistent collection and routine analysis of patient outcomes after telemedicine interventions. International legislation is needed for telemedicine capacity building, reimbursement policy, and secure data sharing policies