Sanid. mil. 2020; 76 (3) 161
REVISIÓN SISTEMÁTICA
Review of effectiveness criteria in the application
of Telemedicine
Monfort-Vinuesa C.1, Gil-López P.2, Ramírez-Olivencia G.3, Chivato-Pérez T.4, Coca-Benito D.5,
Fernández-Bermejo L.6
Sanid. mil. 2020; 76 (3): 161-169, ISSN: 1887-8571
RESUMEN
La telemedicina es una herramienta y recurso de gran utilidad para el diagnóstico y tratamiento médico. Desde su inicio en la década
de los 70 se ha desarrollado de forma progresiva, demostrando el beneficio clínico que aporta a los pacientes y estando cada vez más
presente en la actividad diaria de los clínicos. Diferentes estudios han tratado de definir y acotar su efectividad a la hora de aplicarse
versus la asistencia presencial, siendo esta una variable importante a despejar. Este artículo realiza una revisión de las diferentes
variables que se han acuñado para definir efectividad a la hora de tratar de demostrar la rentabilidad de incluir la telemedicina en la
actividad asistencial diaria.
PALABRAS CLAVE: Telemedicina, e-salud, salud-móvil, efectividad, rentabilidad, ciencias económicas, militar.
SUMMARY
Telemedicine is a very useful tool and resource for medical diagnosis and treatment. Since its inception in the 70s it has developed
progressively, demonstrating the clinical benefit it brings to patients and being increasingly present in the daily activities of clinicians.
Different studies have tried to define and limit its effectiveness at the time of application versus face-to-face assistance, this being an
important variable to clarify. This article reviews the different variables that have been coined to define the effectiveness when trying
to demonstrate the cost-effectiveness of including telemedicine in daily healthcare activity.
KEY WORDS: Telemedicine, e-health, mHealth, effectiveness, cost-effectiveness, economics, military.
INTRODUCTION
Telemedicine is a term that was coined in the 70s with a lit-eral
meaning of «healing at a distance» (1). There are different
meanings that try to define Telemedicine according to different
health-related organizations. WHO (World Health Organiza-tion)
defines it as «the provision health care services, in which
distance is a critical factor, by professionals that leverage infor-mation
and communication technology to exchange data to di-agnose,
recommend treatments and prevent diseases and acci-dents,
as well as to continuously train healthcare professionals
and perform assessment and research activities, with the objec-tive
to improve the health of the people and the communities
in which they live» (2). On its own, the American Telemedicine
Association restricts the term «Telemedicine» to «the exchange
of health information from one place to another, using electron-ic
1 FEA Medicina Interna. Hospital La Fuenfría. SERMAS. Cercedilla (Madrid)
2 Teniente Coronel Médico. Jefe Servicio de Telemedicina. Hospital Central de la De-fensa
«Gómez Ulla». Madrid.
3 FEA Medicina Interna. UAAN. Sección de Infecciosas. Hospital Central de la Defen-sa
«Gómez Ulla». Madrid.
4 Decano de la Facultad de Medicina. Universidad San Pablo CEU. Madrid
5 Comandante Médico. Adjunto Servicio de Urgencias. Hospital Central de la Defensa
«Gómez Ulla». Madrid.
6 FEA Medicina Interna. Hospital La Fuenfría. SERMAS. Cercedilla (Madrid)
Dirección para correspondencia: carlos.monfort@salud.madrid.org. Tfno. contacto
610521473.
Recibido: 16 de febrero de 2020
Aceptado: 21 de septiembre de 2020
doi: 10.4321/S1887-85712020000300004
communication means, for the health and education of the
patient or the healthcare services provider, and with the objective
to improve the patient’s care»(. (3)
In 1993 the term Telemedicine (4) was indexed in MeSH
(Medical Subject Headings) in Medline. This can be considered
as the beginning of Telemedicine Modern Age that lasts till to-day.
Recent progress and the increasing availability and usabili-ty
of ICTS (Information and Communication Technology Ser-vices)
by the general population have been the main reason for
the growth of telemedicine in the last decade, creating new op-portunities
for the service and the provision of healthcare in a
swift manner, mainly in emerging markets and in remote areas
in developed countries (5) where there is a lower penetration of
healthcare services.
The replacement of analogue communication by digital
communication, combined with the fast decrease in ICT costs,
has raised a significant interest in telemedicine by healthcare ser-vices
providers and has enabled healthcare organizations to pro-vide
services to the population in more efficient ways (6)(7). The
introduction and generalization of Internet services, as well as
the ease of access to electronic devices has accelerated even more
the rhythm of progress in ICT, broadening the scope of telemed-icine
to include applications based on Web services (email, tele
consultations, Internet conferences) and multimedia approaches
(digital images and video) (8)
In Spain, the Telemedicine Service in the Hospital Central
de la Defensa «Gómez Ulla» (HCDGU) started in 1996. This
service, named Telemedicine Unit, was the first Telemedicine
Service in Spain. Since then it has accomplished several missions