This review suggests limited research providing scientifically valid and reproducible usability evaluation at various stages of telemedicine system development. Telemedicine system designers need to consider the age-related issues in cognition, perception, and behavior of geriatric patients while designing telemedicine applications. Future directions for research were developed based on the limitations as well as other results found in this systematic review.

Although this review identified life-saving benefits of telemedicine, it also showed the paucity of the scientifically sound research in its implementation, prompting further studies. Further research is needed to analyze the capabilities and challenges involved in implementing telemedicine in ambulances, especially studies focusing on human-system integration and human factors' considerations in the implementation of telemedicine systems in ambulances, the development of advanced Internet connectivity paradigms, additional applications for triaging, and the implications of ambulance location.

BackgroundDirect-to-consumer (DTC) telemedicine providers has the potential to change the traditional patient-physician relationship. Professional medical organizations recommend that telemedicine exist within the medical home. This study aims to understand patients’ preferences and desires for DTC telemedicine.MethodsWe conducted a nationwide survey of 4345 survey respondents demographically balanced to represent the United States adult population. The survey consisted of questions assessing the respondents’ attributes and their willingness and comfortability using telemedicine as well as the importance and desired attributes of a provider providing care via telemedicine.ResultsRelatively few respondents (3.5%) had ever had an online video visit with their care provider. Respondents were more willing to see their own provider via telemedicine than unwilling (52% vs. 25%). Additionally, respondents were less willing to use telemedicine to see a different provider from the same healthcare organization (35%) and were least willing to see a different provider from a different organization (19%). Forty-one percent of respondents felt it was unimportant that their current provider offer telemedicine, and only 15% would consider leaving their current provider to a new provider who offers telemedicine as an option. More than half (56%) of respondents felt it was important to have an established relationship with a provider they’re having a telemedicine visit with. Nearly two-thirds of respondents (60%) felt it was important for a telemedicine provider to have access to their health records.ConclusionsPatients prefer to use telemedicine with their own doctor with whom they have an established relationship.

Lack of recruitment of qualified research participants continues to be a significant bottleneck in clinical trials, often resulting in costly time extensions, underpowered results, and in some cases early termination. Some of the reasons for suboptimal recruitment include laborious consent processes and access to participants at remote locations. While new electronic consents technologies (eConsent) help overcome challenges related to readability and consent management, they do not adequately address challenges related to remote access. To address this, we have developed an innovative solution called “teleconsent”, which embeds the informed consent process into a telemedicine session. Teleconsent allows a researcher to remotely video conference with a prospective research participant, display and interactively guide participants in real-time through a consent form. When finished, the researcher and participant can electronically sign the consent form and print or download the signed document for archiving. This process can eliminate challenges related to travel and management of personnel at remote sites. Teleconsent has been successfully implemented in several clinical trials. Teleconsent can improve research recruitment by reducing the barriers related to informed consent, while preserving human interaction.

To maximize the clinical benefits arising from ongoing discoveries in genetics and genomics, additional research and development is recommended for identifying how best to leverage CDS to bridge the gap between the promise and realization of GPM.