Introduction
Definitions of telemedicine by the Institute of Medicine (IOM), World Health Organization, and American Telemedicine Association [1], [2], [3] vary somewhat, but the core of most definitions is “the delivery of health care services at a distance, using information and communication technology”, where information and communication technology encompasses a broad range of potential applications [4]. Many telemedicine applications connect patients directly to providers. Other applications focus on clinicians but employ asynchronous communication only, or largely use videoconferencing for educational purposes. An extremely important area of telemedicine connects clinicians during an acute episode of patient care, usually linking small, rural hospital settings that have limited resources to larger, urban medical centers. Telemedicine applications in emergency rooms (tele-emergency) are a prime example. In a recent analysis of the 2011 Health Information and Management Systems Society (HIMSS) Analytics dataset [5], which aimed at deriving national estimates of hospital-based telemedicine use, we found that two of the three most frequently used services were in emergency/trauma care departments and in cardiology/stroke/heart attack programs [6].
Despite this reported frequency of use of telemedicine in emergency care, limited evidence exists on its impacts at various levels related to the technical quality, users’ perceptions, clinical processes and outcomes, disposition and throughput of patients, and economic effects. Hospital-based applications of telemedicine present a potentially important solution, particularly for small and rural hospitals where access to local specialists is rarely available [7]. Yet, a PubMed search for meta-analyses and systematic reviews on telemedicine and telehealth yielded 55 citations, of which only three are focused on hospital-based applications [8], [9], [10]. Interestingly, all three were on telemedicine in intensive care units (ICU). A systematic review on a broad range of applications [11] found generally positive results with the strongest evidence among hospital-based applications in pediatric cardiology, intensive care, and emergency care/trauma. Surprisingly, no meta-analyses or systematic reviews of telemedicine in specific hospital-based applications other than those covering tele-ICU [12] were found. Thus, in view of the relatively frequent use of telemedicine in emergency/trauma care departments and cardiology/stroke/heart attack programs, we undertook a systematic review of the empirical studies of telemedicine applications for hospital-based emergency care to synthesize the existing evidence on the impact of tele-emergency applications, which could inform future efforts and research in this area. This paper presents a systematic review of published research evidence on tele-emergency applications, which synthesizes existing evidence and identifies knowledge gaps in this area. It further provides stakeholders, researchers, and funding agencies with knowledge that focuses attention on priority areas for future investigation, as well as highlights various evidence-based interventions of telemedicine applications in emergency room settings.