London School of Hygiene and Tropical Medicine, United Kingdom.
Int J Med Inform. 2012 Dec;81(12):793-809. doi: 10.1016/j.ijmedinf.2012.08.003. Epub 2012 Sep 11.
Innovative technologies to deliver health care across borders have attracted both evangelists and sceptics. Our aim was to systematically identify factors that hinder or support implementation of cross-border telemedicine services worldwide in the last two decades.
Two reviewers independently searched ten databases including MEDLINE and EMBASE, in June 2011 including citations from 1990 onwards when at least an abstract was available in English. We also searched ELDIS and INTUTE databases and Internet search engines to identify grey literature. We included studies which (a) described the use of telemedicine to deliver cross-border healthcare and, or (b) described the factors that hinder or support implementation of cross-border telemedicine services. All study designs were included. Two reviewers independently assessed titles and abstracts of articles identified. Papers were allocated to one of four reviewers who extracted relevant data and validated it. We took a qualitative approach to the analysis, conducting a narrative synthesis of the evidence.
6026 records were identified of which 5806 were excluded following screening of titles and abstracts. We assessed 227 full text articles, excluding 133 because they were fatally flawed or did not meet the inclusion criteria, producing a final sample of 94. They involved 76 countries worldwide, most involving collaborations between high and low or middle income countries. Most described services delivering a combination of types of telemedicine but specialties most represented were telepathology, telesurgery, Emergency and trauma telemedicine and teleradiology. Most link health professionals, with only a few linking professionals directly to patients. A main driver for the development of cross-border telemedicine is the need to improve access to specialist services in low and middle income countries and in underserved rural areas in high income countries. Factors that hinder or support implementation clustered into four main themes: (1) legal factors; (2) sustainability factors; (3) cultural factors; and (4) contextual factors.
National telemedicine programmes may build infrastructure and change mindsets, laying the foundations for successful engagement in cross-border services. Regional networks can also help with sharing of expertise and innovative ways of overcoming barriers to the implementation of services. Strong team leadership, training, flexible and locally responsive services delivered at low cost, using simple technologies, and within a clear legal and regulatory framework, are all important factors for the successful implementation of cross-border telemedicine services.
创新技术可以实现跨境医疗服务，这引起了拥护者和怀疑论者的关注。我们的目的是系统地确定过去 20 年来在全球范围内实施跨境远程医疗服务的障碍和支持因素。
两位评审员于 2011 年 6 月独立检索了包括 MEDLINE 和 EMBASE 在内的 10 个数据库，检索范围涵盖了 1990 年以来至少有英文摘要的文献。我们还检索了 ELDIS 和 INTUTE 数据库和互联网搜索引擎，以确定灰色文献。我们纳入了描述使用远程医疗提供跨境医疗保健的研究，以及/或者描述阻碍或支持跨境远程医疗服务实施的因素的研究。所有研究设计均被纳入。两位评审员独立评估了确定的文章标题和摘要。将论文分配给四位评审员中的一位，以提取相关数据并进行验证。我们采用定性方法进行分析，对证据进行叙述性综合。
共确定了 6026 条记录，其中 5806 条在筛选标题和摘要后被排除。我们评估了 227 篇全文文章，排除了 133 篇因存在致命缺陷或不符合纳入标准的文章，最终样本为 94 篇。这些研究涉及全球 76 个国家，其中大多数涉及高收入和低收入或中等收入国家之间的合作。大多数研究涉及提供多种类型远程医疗服务的服务，但最具代表性的专业是远程病理学、远程手术、急诊和创伤远程医疗以及远程放射学。大多数研究将卫生专业人员联系在一起，只有少数研究将专业人员直接与患者联系在一起。跨境远程医疗发展的主要驱动力是改善低收入和中等收入国家以及高收入国家服务不足的农村地区获得专科服务的机会。阻碍或支持实施的因素可分为四个主要主题：（1）法律因素；（2）可持续性因素；（3）文化因素；和（4）背景因素。
国家远程医疗计划可以建立基础设施和改变思维模式，为成功参与跨境服务奠定基础。区域网络还可以帮助共享专业知识和创新方式来克服服务实施的障碍。强大的团队领导力、培训、灵活和对当地需求做出响应的低成本服务、使用简单技术以及在明确的法律和监管框架内，都是跨境远程医疗服务成功实施的重要因素。
