Document Type : Original Article


1 Department of Health Information Technology, School of Paramedical, Ilam University of Medical Sciences, Ilam, Iran

2 Department of Heath Information Technology, Abadan University of Medical Sciences, Abadan, Iran, Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran

3 Department of Public Health, Abadan University of Medical Sciences, Abadan, Iran

4 Department of Biochemistry, School of Medicine Biotechnology and Medicinal Plants Research Center, Ilam University of Medical Sciences, Ilam, Iran


With the onset of the coronavirus disease 2019 (COVID‑19) outbreak, the transformation of the care
delivery model from conventional in-person (face to face) to largely virtual or remote care has been
accelerated to appropriately allocate resources and constrain the spread of the virus. In this regard,
telemedicine is a breakthrough technology to battle against the COVID‑19 emergency. Therefore, we
sought to identify the telemedicine applications in the COVID‑19 pandemic (tele‑COVID) according
to interaction modes, transmission modalities, and disease categories. This systematic review
was conducted through searching five databases including PubMed, Scopus, ProQuest, Web of
Science, and Science Direct. Inclusion criteria were studies clearly outlining any use of telemedicine
interactive mode during the COVID‑19 pandemic, written in English language and published in
peer-reviewed journals in 2020. Finally, 43 articles met the inclusion out of the 1118 search results.
Telemedicine provides a diversity of interaction modes and modalities affordable by patients and
physicians including short message service, E-mail and web portals, secure telephone calls or VOIP,
video calls, interactive mobile health applications (m-Health), remote patient monitoring, and video
conferencing. Transmission of video data using synchronized video calls via common social media
had the highest and exchange of data using store-forward service via secure messaging technology
and prerecorded multimedia had the lowest popularity for virtual disease management during the
COVID‑19 outbreak. Selection of telemedicine communication services and interaction modes with
regard to its use‑case, disease category, and application plays a significant role in the success of
remote disease management infrastructures in this scenario and their implication for a better future
healthcare system.


  1. Araz  OM, Ramirez‑Nafarrate  A, Jehn  M, Wilson  FA. The
    importance of widespread testing for COVID‑19 pandemic:
    Systems thinking for drive‑through testing sites. Health
    Syst (Basingstoke) 2020;9:1‑5.
    2. Vadukul P, Sharma DS, Vincent P. Massive pulmonary embolism
    following recovery from COVID‑19 infection: Inflammation,
    thrombosis and the role of extended thromboprophylaxis. BMJ
    Case Rep 2020;13:e238168.
    3. Bahl  P, de Silva  C, Bhattacharjee  S, Stone  H, Doolan  C,
    Chughtai AA, et al. Droplets and Aerosols generated by singing
    and the risk of COVID‑19 for choirs. Clin Infect Dis. 2020 Sep 18;
    4. Zhao  Y, Chen  Q, Guo  Q, Chen  N, Hou  W, Wang  Y, et al.
    Performing EUS during COVID‑19 postendemic period: A report
    from endoscopy center in Wuhan. Endosc Ultrasound 2020;27:
    37‑ 46.
    5. Arefi MF, Poursadeqiyan M. A review of studies on the COVID‑19
    epidemic crisis disease with a preventive approach. Work
    6. Matouk AE. Complex dynamics in susceptible‑infected models
    for COVID‑19 with multi‑drug resistance. Chaos Solitons Fractals
    7. Contreras  CM, Metzger  GA, Beane  JD, Dedhia  PH, Ejaz  A,
    Pawlik TM. Telemedicine: Patient‑provider clinical engagement
    during the COVID‑19 pandemic and beyond. J Gastrointest Surg
    8. Gates  B. Responding to COVID‑19  –  A once‑in‑a‑century
    pandemic? N Engl J Med 2020;382:1677‑9.
    9. Wang  D, Hu  B, Hu  C, Zhu  F, Liu  X, Zhang  J, et al. Clinical
    characteristics of 138 hospitalized patients with 2019 novel
    coronavirus‑infected pneumonia in Wuhan, China. JAMA
    10. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features
    of patients infected with 2019 novel coronavirus in Wuhan, China.
    Lancet 2020;395:497‑506.
    11. Webb R. COVID‑19 and lockdown: living in ‘interesting times’.
    J Wound Care. 2020 May 2;29 (5):243.
    12. Mikolajczyk D, Schubert J, Khosrawipour T. The positive impact
    of lockdown in Wuhan on containing the COVID‑19 outbreak in
    China. J Travel Med. 2020 May 18;27 (3): 37.
    13. Bashshur R, Doarn CR, Frenk JM, Kvedar JC, Woolliscroft JO.
    Telemedicine and the COVID‑19 Pandemic, Lessons for the
    Future. Telemed J E Health. 2020 May; 26 (5):571‑573.
    14. Barney A, Buckelew S, Mesheriakova V, Raymond‑Flesch M. The
    COVID‑19 pandemic and rapid implementation of adolescent
    and young adult telemedicine: Challenges and opportunities for
    innovation. J Adolesc Health 2020;67:164‑71.
    15. Rockwell  KL, Gilroy  AS. Incorporating telemedicine as part
    of COVID‑19 outbreak response systems. Am J Manag Care
    16. Fix OK, Serper M. Telemedicine and telehepatology during the COVID-19 pandemic. Clin Liver Dis 2020;15:187.
    17. Kang S, Thomas PBM, Sim DA, Parker RT, Daniel C, Uddin JM.
    Oculoplastic video‑based telemedicine consultations: COVID‑19
    and beyond. Eye (Lond) 2020;34:1‑3.
    18. Rao SS, Loeb AE, Amin RM, Golladay GJ, Levin AS, Thakkar SC.
    Establishing telemedicine in an academic total joint arthroplasty
    practice: Needs and opportunities highlighted by the COVID‑19
    Pandemic. Arthroplast Today 2020;6:617‑22.
    19. Liu  R, Sundaresan  T, Reed  ME, Trosman  JR, Weldon  CB,
    Kolevska  T. Telehealth in oncology during the COVID‑19
    outbreak: Bringing the house call back virtually. JCO Oncol Pract
    20. Al‑Benna S. Availability of COVID‑19 information from national
    and international aesthetic surgery society websites. Aesthetic
    Plast Surg 2020;44:1043‑6.
    21. Smith  AC, Thomas  E, Snoswell  CL, Haydon  H, Mehrotra  A,
    Clemensen J, et al. Telehealth for global emergencies: Implications
    for coronavirus disease 2019  (COVID‑19). J  Telemed Telecare
    22. Portnoy  J, Waller  M, Elliott  T. Telemedicine in the Era of
    COVID‑19. J Allergy Clin Immunol Pract 2020;8:1489‑91.
    23. Fatyga  E, Dzięgielewska‑Gęsiak S, Wierzgoń A, Stołtny D,
    Muc‑Wierzgoń M. The coronavirus disease 2019 pandemic:
    Telemedicine in elderly patients with type 2 diabetes. Pol Arch
    Intern Med 2020;130:452‑4.
    24. Reiss  AB, De Leon  J, Dapkins  IP, Shahin  G, Peltier  MR,
    Goldberg ER. A Telemedicine approach to Covid‑19 assessment
    and triage. Medicina (Kaunas). 2020 Sep 10;56 (9):461.
    25. Wahezi SE, Duarte RV, Yerra S, Thomas MA, Pujar B, Sehgal N,
    et al. Telemedicine during COVID‑19 and beyond: A practical
    guide and best practices multidisciplinary approach for the
    orthopedic and neurologic pain physical examination. Pain
    Physician 2020;23:S205‑S238.
    26. Moher  D, Liberati  A, Tetzlaff  J, Altman  DG, PRISMA
    Group. Preferred reporting items for systematic reviews
    and meta‑analyses: The PRISMA statement. Int J Surg
    27. Saleem  SM, Pasquale  LR, Sidoti  PA, Tsai  JC. Virtual
    ophthalmology: Telemedicine in a COVID‑19 Era. Am J
    Ophthalmol 2020;216:237‑42.
    28. Shokri T, Lighthall JG. Telemedicine in the Era of the COVID‑19
    pandemic: Implications in facial plastic surgery. Facial Plast Surg
    Aesthet Med 2020;22:155‑6.
    29. Boehm  K, Ziewers  S, Brandt  MP, Sparwasser  P, Haack  M,
    Willems  F, et al. Telemedicine online visits in urology during
    the COVID‑19 pandemic – Potential, risk factors, and patients’
    perspective. Eur Urol 2020;78:16‑20.
    30. Shipchandler  TZ, Nesemeier  BR, Parker  NP, Vernon  D,
    Campiti VJ, Anthony BP, et al. Telehealth opportunities for the
    otolaryngologist: A silver lining during the COVID‑19 pandemic.
    Otolaryngol Head Neck Surg 2020;163:112‑3.
    31. Gutierrez J, Kuperman E, Kaboli PJ. Using telehealth as a tool
    for rural hospitals in the COVID‐19 pandemic response. J Rural
    Health. 2020 Apr 11:10.1111/jrh. 12443.
    32. Chou  E, Hsieh  YL, Wolfshohl  J, Green  F, Bhakta  T. Onsite
    telemedicine strategy for coronavirus (COVID‑19) screening to
    limit exposure in ED. Emerg Med J 2020;37:335‑7.
    33. Del Hoyo J, Aguas M. Implementing telemedicine in inflammatory
    bowel disease: Is COVID‑19 the definitive trigger? Gastroenterol
    Hepatol 2020;43:415‑7.
    34. Ghai B, Malhotra N, Bajwa SJS. Telemedicine for chronic pain
    management during COVID‑19 pandemic. Indian J Anaesth
    35. Daggubati  LC, Eichberg  DG, Ivan  ME, Hanft  S, Mansouri  A,
    Komotar  RJ, et al. Telemedicine for outpatient neurosurgical
    oncology care: Lessons learned for the future during the
    COVID‑19 pandemic. World Neurosurg 2020;139:e859‑63.
    36. Berg EA, Picoraro JA, Miller SD, Srinath A, Franciosi JP, Hayes CE,
    et al. COVID‑19 – A guide to rapid implementation of telehealth
    services: A playbook for the pediatric gastroenterologist. J Pediatr
    Gastroenterol Nutr 2020;70:734.
    37. Grimes  CL, Balk  EM, Crisp  CC, Antosh  DD, Murphy  M,
    Halder GE, et al. A guide for urogynecologic patient care utilizing
    telemedicine during the COVID‑19 pandemic: Review of existing
    evidence. Int Urogynecol J 2020;31:1063‑89.
    38. Zhou X, Snoswell CL, Harding LE, Bambling M, Edirippulige S,
    Bai X, et al. The Role of Telehealth in Reducing the Mental Health
    Burden from COVID‑19. Telemed J E Health 2020;26:377‑9.
    39. Mann  DM, Chen  J, Chunara  R, Testa  PA, Nov  O. COVID‑19
    transforms health care through telemedicine: Evidence from the
    field. J Am Med Inform Assoc 2020;27:1132‑5.
    40. Gadzinski  AJ, Andino  JJ, Odisho  AY, Watts  KL, Gore  JL,
    Ellimoottil  C. Telemedicine and eConsults for hospitalized
    patients during COVID‑19. Urology 2020;141:12‑4.
    41. Lee  AC. COVID‑19 and the advancement of digital physical
    therapist practice and telehealth. Phys Ther 2020;100:1054‑7.
    42. Rogers BG, Coats CS, Adams E, Murphy M, Stewart C, Arnold T,
    et al. Development of telemedicine infrastructure at an LGBTQ+
    clinic to support HIV prevention and care in response to
    COVID‑19, Providence, RI. AIDS Behav 2020;24:2743‑7.
    43. Goodman‑Casanova  JM, Dura‑Perez  E, Guzman‑Parra  J,
    Cuesta‑Vargas A, Mayoral‑Cleries F. Telehealth home support
    during COVID‑19 confinement for community‑dwelling older
    adults with mild cognitive impairment or mild dementia: Survey
    study. J Med Internet Res 2020;22:e19434.
    44. Mihalj  M, Carrel  T, Gregoric  ID, Andereggen  L, Zinn  PO,
    Doll D, et al. Telemedicine for preoperative assessment during
    a COVID‑19 pandemic: Recommendations for clinical care. Best
    Pract Res Clin Anaesthesiol 2020;34:345‑51.
    45. Punia  V, Nasr  G, Zagorski  V, Lawrence  G, Fesler  J, Nair  D,
    et al. Evidence of a rapid shift in outpatient practice during the
    COVID‑19 pandemic using telemedicine. Telemed J E Health
    46. Triantafillou V, Rajasekaran K. A commentary on the challenges
    of telemedicine for head and neck oncologic patients during
    COVID‑19. Otolaryngol Head Neck Surg 2020;163:81‑2.
    47. Mgbako O, Miller EH, Santoro AF, Remien RH, Shalev N, Olender S,
    et al. COVID‑19, telemedicine, and patient empowerment in HIV
    care and research. AIDS Behav 2020;24:1990‑3.
    48. Moring JC, Dondanville KA, Fina BA, Hassija C, Chard K, Monson C,
    et al. Cognitive processing therapy for posttraumatic stress disorder
    via telehealth: practical considerations during the COVID-19
    pandemic. J Trauma Stress. 2020 May 13:10.1002/jts. 22544.
    49. Pollock K, Setzen M, Svider PF. Embracing telemedicine into your
    otolaryngology practice amid the COVID‑19 crisis: An invited
    commentary. Am J Otolaryngol 2020;41:102490.
    50. Smith  WR, Atala  AJ, Terlecki  RP, Kelly  EE, Matthews  CA.
    Implementation Guide for rapid integration of an outpatient
    telemedicine program during the COVID‑19 pandemic. J  Am
    Coll Surg 2020;231:216‑2200.
    51. Lee  AK, Cho  RH, Lau  EH, Cheng  HK, Wong  EW, Ku  PK,
    et al. Mitigation of head and neck cancer service disruption
    during COVID-19 in Hong Kong through telehealth and multiinstitutional collaboration. Head Neck 2020;42:1454‑9.
    52. Nagra M, Vianya‑Estopa M, Wolffsohn JS. Could telehealth help
    eye care practitioners adapt contact lens services during the
    COVID‑19 pandemic? Cont Lens Anterior Eye 2020;43:204‑7.
    53. Zughni  LA, Gillespie  AI, Hatcher  JL, Rubin  AD, Giliberto  JP.
    Telemedicine and the Interdisciplinary Clinic Model: During the
    COVID‑19 Pandemic and Beyond. Otolaryngol Head Neck Surg
    54. Prasad  A, Carey  RM, Rajasekaran  K. Head and neck virtual
    medicine in a pandemic era: Lessons from COVID-19. Head Neck
  2. 55. Prasad A, Brewster R, Newman JG, Rajasekaran K. Optimizing
    your telemedicine visit during the COVID-19 pandemic: Practice
    guidelines for patients with head and neck cancer. Head Neck
    56. Layfield  E, Triantafillou  V, Prasad  A, Deng  J, Shanti  RM,
    Newman JG, et al. Telemedicine for head and neck ambulatory
    visits during COVID-19: Evaluating usability and patient
    satisfaction. Head Neck 2020;42:1681‑9.
    57. Tenforde AS, Iaccarino MA, Borgstrom H, Hefner JE, Silver J,
    Ahmed  M, et al. Feasibility and high quality measured in the
    rapid expansion of telemedicine during COVID-19 for sports and
    musculoskeletal medicine practice. PM&R 2020; 12 (9): 154.
    58. Vaishya R, Javaid M, Khan IH, Haleem A. Artificial Intelligence (AI)
    applications for COVID‑19 pandemic. Diabetes Metab Syndr
    59. Sullivan AB, Kane A, Roth AJ, Davis BE, Drerup ML, Heinberg LJ.
    The COVID‑19 crisis: A mental health perspective and response
    using telemedicine. J Patient Exp 2020;7:295‑301.
    60. Gadzinski  AJ, Ellimoottil  C. Telehealth in urology after the
    COVID‑19 pandemic. Nat Rev Urol 2020;17:363‑4.
    61. Peters AL, Garg SK. The silver lining to COVID‑19: Avoiding
    diabetic ketoacidosis admissions with telehealth. Diabetes
    Technol Ther 2020;22:449‑53.
    62. Serper M, Cubell AW, Deleener ME, Casher TK, Rosenberg DJ,
    Whitebloom D, et al. Telemedicine in liver disease and beyond:
    Can the COVID-19 crisis lead to action? Hepatology 2020;72:723‑8.
    63. Aziz A, Zork N, Aubey JJ, Baptiste CD, D’Alton ME, Emeruwa UN,
    et al. Telehealth for high‑risk pregnancies in the setting of the
    COVID‑19 pandemic. Am J Perinatol 2020;37:800‑8.
    64. Parikh A, Kumar AA, Jahangir E. Cardio‑oncology care in the
    time of COVID‑19 and the role of telehealth. JACC CardioOncol
    65. Parisien  RL, Shin  M, Constant  M, Saltzman  BM, Li  X,
    Levine WN, et al. Telehealth utilization in response to the novel
    coronavirus (COVID‑19) pandemic in orthopaedic surgery. J Am
    Acad Orthop Surg 2020;28:e487‑e492.
    66. Ohannessian  R, Duong  TA, Odone  A. Global telemedicine
    implementation and integration within health systems to fight
    the COVID‑19 pandemic: A call to action. JMIR Public Health
    Surveill 2020;6:e18810.
    67. Goodman CW, Brett AS. Accessibility of virtual visits for urgent
    care among US hospitals: A descriptive analysis. J Gen Intern
    Med. 2020 May 18:1–2.
    68. Koziatek CA, Rubin A, Lakdawala V, Lee DC, Swartz J, Auld E,
    et al. Assessing the impact of a rapidly scaled virtual urgent care
    in New York City during the COVID‑19 pandemic. J Emerg Med
    69. Hakim AA, Kellish AS, Atabek U, Spitz FR, Hong YK. Implications
    for the use of telehealth in surgical patients during the COVID‑19
    pandemic. Am J Surg 2020;220:48‑9.
    70. El‑Lababidi RM, Mooty M, Bonilla MF, Salem NM. Treatment of
    severe pneumonia due to COVID‑19 with peginterferon alfa 2a.
    IDCases 2020;21:e00837.
    71. Nahm  WJ, Badiavas  EV, Kirsner  RS, Nichols  AJ, Harris  ZC,
    Phillips AR, et al. Treating keratinocyte carcinomas with a
    combination of imiquimod, 5‑fluorouracil, and tretinoin using
    store‑and‑forward telemedicine in the age of coronavirus disease
    2019 to promote social distancing. JAAD Case Rep 2020;6:931‑4.
    72. Chowdhury  SR, Sunna  TC, Ahmed  S. Telemedicine is an
    important aspect of healthcare services amid COVID‑19 outbreak:
    Its barriers in Bangladesh and strategies to overcome. Int J Health
    Plann Manage. 2020 Aug 28.
    73. Klein  BC, Busis  NA. COVID‑19 is catalyzing the adoption of
    teleneurology. Neurology 2020;94:903‑4.
    74. Wosik J, Fudim M, Cameron B, Gellad ZF, Cho A, Phinney D,
    et al. Telehealth transformation: COVID‑19 and the rise of virtual
    care. J Am Med Inform Assoc 2020;27:957‑62.
    75. Olayiwola JN, Magaña C, Harmon A, Nair S, Esposito E, Harsh C,
    et al. Telehealth as a bright spot of the COVID‑19 pandemic:
    Recommendations from the virtual frontlines (“Frontweb”). JMIR
    Public Health Surveill 2020;6:e19045.
    76. Mouchtouris  N, Lavergne  P, Montenegro  TS, Gonzalez  G,
    Baldassari  M, Sharan  A, et al. Telemedicine in neurosurgery:
    lessons learned and transformation of care during the COVID‑19
    pandemic. World Neurosurg 2020;140:e387‑94.