Most systematic reviews addressing the impact of real-time telehealth, just as the original studies that they reviewed, had low methodological quality. This absence of evidence of effect does not mean that telehealth is ineffective. It may illustrate that many researchers and policy makers lack the methodological support and resources needed to design and conduct valid, precise, and relevant studies.
Despite its weaknesses, the evidence available from high quality reviews provides an indication of the benefits of real-time telehealth. In terms of health outcomes, there is support for the use of homebased telemedicine for patients' self-care or the management of chronic disease, to improve communication between patient and provider, to contribute to closer monitoring of chronic conditions, or to enhance the quality of life in elder care. In cases such as congestive heart failure, the use of home-based telehealth as part of a multidisciplinary interventional program could result in reduced mortality.
Real-time telehealth could provide an effective way to meet the needs of health professionals and patients with psychiatric and neurological conditions in remote, under-served communities. In these areas, real-time telehealth leads to health outcomes that are equivalent to those obtained through inperson interactions.
The data reveal that there is growth in real-time telehealth services throughout Canada. There remains, however, continued independent evolution of programs and limited collaborative work across provinces.
With its aging population, vast geographic area, limited health care workforce, and rapidly developing telehealth programs, Canada is in a unique position to pave the way for effective and efficient health services that result in equitable, fair, and sustainable health care delivery for its citizens. Although weak, the evidence gathered suggests that telehealth could play a role in this process.