Intended for healthcare professionals

Clinical Review

Telehealthcare for long term conditions

BMJ 2011; 342 doi: (Published 03 February 2011) Cite this as: BMJ 2011;342:d120
  1. Susannah McLean, clinical research fellow1,
  2. Denis Protti, professor of health informatics2,
  3. Aziz Sheikh, professor of primary care research and development1
  1. 1eHealth Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK
  2. 2University of Victoria, Victoria, BC, Canada
  1. Correspondence to: A Sheikh aziz.sheikh{at}
  • Accepted 29 December 2010

Summary points

  • Telehealthcare is personalised healthcare delivered over a distance; data are transferred from the patient to the professional, who then provides feedback

  • In patients with severe long term conditions, such as problematic asthma and diabetes, telehealthcare can reduce hospital admissions without increasing mortality

  • Potential pitfalls include user interface problems, technical problems, and safety concerns such as data loss and confidentiality

  • Telehealthcare can alter the doctor-patient relationship so try to humanise the interaction

  • Consider workflows, to minimise unintended disruptions to normal routines

  • Careful assessment of effectiveness, cost effectiveness, and safety considerations is needed before introduction

Telehealthcare is the provision of personalised healthcare over a distance.1 It has the three following essential components2w1:

  • The patient provides data such as a voice recording, video, electrocardiography, or oxygen saturation that gives information about the illness.

  • Information is transferred electronically to a healthcare professional at a second location.

  • The healthcare professional uses clinical skills and judgment to provide personalised feedback tailored to the individual.

Telehealthcare can be delivered by both synchronous and asynchronous (such as store and forward) technologies (fig 1). For example, telephone and video conferencing enable consultations in real time. An example of asynchronous communication would be storing two weeks’ of spirometry results in a batch and forwarding these on to a healthcare provider, who responds by email or telephone.

Telehealthcare is related to, but distinct from telemedicine, where technology is used to share information over a distance between healthcare providers.2

Fig 1 Key elements of telehealthcare

Sources and selection criteria

We identified systematic reviews and original research studies on telehealthcare and long term conditions. We used searches from our ongoing Cochrane systematic reviews to find randomised controlled trials for telehealthcare interventions for asthma and chronic obstructive pulmonary disease. Search terms were telehealth, tele-health, telemedicine, tele-medicine, internet, computer, web, interactive, telecommunication, telephone, …

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