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Jou nal o In o ma ion Sys ems Enginee ing and Managemen
2023, 8(1), 19138
e-ISSN: 2468-4376
h ps://www.jisem-jou nal.com/
Li e a u e Re iew
Adop ion o Telemedicine du ing he COVID-19
pandemic in Ibe o-Ame ica: A Sys ema ic Li e a u e
Re iew
Agos inho Sousa Pin o 1, An ónio Ab eu 1, Eusébio Cos a 2, Je ónimo Pai a 1 *, Laís Viei a3
1 CEOS.PP, Poly echnic o Po o / ISCAP, Po ugal
2 Technology School o Fa e, Fa e, Po ugal
3 EPIUni - Ins i u e o Public Heal h, Uni e si y o Po o, Po ugal
*
Co esponding Au ho :
je [email protected]
Ci a ion: Pin o, A. S., Ab eu, A., Cos a, E., Pai a, J., & Viei a, L. (2023). Adop ion o Telemedicine du ing he COVID-19 pandemic in Ibe o-
Ame ica: A Sys ema ic Li e a u e Re iew. Jou nal o In o ma ion Sys ems Enginee ing and Managemen , 8(1), 19138.
.h ps://doi.o g/10.55267/iad .07.12742
ARTICLE INFO
ABSTRACT
Recei ed: 30 No 2022
Accep ed: 15 Dec 2022
The ou b eak o COVID-
19 caused a majo in e na ional public heal h c isis and led o he imposi ion o social
dis ancing measu es o con ain he sp ead o he i us. In his con ex , he use o eleheal h sky ocke ed as he only
way o deli e heal hca e
o pa ien s du ing a lockdown was emo ely. The coun ies o La in Ame ica and he Ibe ian
Peninsula we e se e ely hi by he pandemic and he p ospec s and challenges associa ed wi h widesp ead adop ion
o eleheal h a e unique. The goal o his sys ema i
c li e a u e e iew is o explo e how eleheal h has been used du ing
he pandemic o p e en , diagnose, ea and con ol diseases in Ibe o-
Ame ica. Thus, we sough o iden i y he main
keywo ds, hemes, heo e ical amewo ks and me hodologies used by e
sea che s in his a ea. We used se e al ools
o bibliog aphic managemen like Rayyan, VOSViewe and NVIVO and ollowed he PRISMA p o ocol. Ou analysis
o hemes showed he exis ence o 3 nodes wi hin he li e a u e: s uden s, eache s and educa ion. A
e sea ching in 6
da abases, 1826 a icles we e ound. A e excluding he duplica es (231 a icles), we sc eened and ead he i les and
abs ac s o 1595 a icles. Only 119 a icles me he inclusion c i e ia. Finally, a e a ull- ex analysis, a ina
l sample o
106 a icles was selec ed o analysis. Spain and B azil a e he coun ies who ha e p oduced he g ea es olume o
esea ch in he egion. The public sec o is he la ges unde o esea ch on his opic by a especially a na ional le el
.
Ou indings show ha he esea ch ou pu in he egion o Ibe o-
Ame ica (La in Ame ica and Ibe ia) on his opic is
s ill ela i ely small when compa ed o egions like No h Ame ica.
Keywo ds: Telemedicine, eHeal h, Sys ema ic Li e a u e Re iew, COVID-19
INTRODUCTION
The mo i a ion behind he choice o his opic o esea ch
ela es o he g owing impo ance o elemedicine in a pos -
pandemic wo ld. By analyzing he exis ing li e a u e on he
adop ion o elemedicine in Ibe o-Ame ica, he goals o his SLR
a e:
 Iden i y he main esea ch hemes, keywo ds and opics;
 Re eal he main esea ch me hodologies;
 Highligh he mos ele an au ho s, jou nals and
coun ies
Telemedicine is he use o In o ma ion and communica ion
echnology (ICT) o deli e heal hca e emo ely (WHO Global
Obse a o y o eHeal h, 2010). Some sys ema ic li e a u e
e iews ollowing he PRISMA p o ocol on he opic o eHeal h
ha e been w i en (Table 1). (Alonso e al., 2021) iden i ied
China and he Uni ed Sa es as he wo coun ies wi h he la ges
numbe o pape s on he opic. The au ho also iden i ied 10
di e en agencies ha a e suppo ing esea ch on elemedicine
and 35 di e en o ganiza ions ha a e in ol ed in he
applica ion o elemedicine sys ems. The mos p ominen
o ganiza ions ha we e esea ching elemedicine applied o
COVID-19 we e Huazhong Uni e si y o Science Technology,
he Uni e si y o Queensland and he Uni e si y o Sou he n
Denma k. Telemedicine whose implemen a ion equi es a
c oss-domain esea ch app oach: 58% o he analyzed a icles
we e published in heal h ca e sciences jou nals, 16% in medical
in o ma ics jou nals and 11% in he public and occupa ional
heal h domain.
Pin o A. e al / J INFORM SYSTEMS ENG, 8(1), 19138
2 / 6
Table 1.
P e ious Sys ema ic Li e a u e Re iews abou elemedicine du ing COVID-19 based on PRISMA
S udy Sea ch Te m Da abases Pape s
(Alonso e al., 2021)
((co ona i us o COVID-19 o SARS-CoV-2)
and ( elemedicine o eHeal h o Tele- heal h o mHea lh o mobile
heal h))
Web o Science 85
(Bokolo An hony
Jn ., 2020)
S ings comp ised o he e ms: ele- heal h, elemedicine,
COVID-19, co ona i us disease 2019, pandemic, digi al heal h,
emo e ca e, hospi al- a -
home, digi alized heal h ca e, digi alized
medical ca e, i ual heal h ca e, i ual medical ca e.
PubMed, Google schola , Scopus, Web o
science, ScienceDi ec , P oQues ,
Eme ald, Taylo & F ancis, Inde science,
Sp inge , Sage, ACM, Wiley, and IEEE
Xplo e
87
(Monaghesh and
Hajizadeh, 2020)
Combina ion o keywo ds: COVID19,
COVID-19, Co ona i us, No el co ona i us, 2019-nCoV,
Wuhan co ona- i us, SARS-CoV-2, SARS2, Tele*,
Telemedicine, Tele-medicine, Tele- heal h, Tele-heal h,
Teleca e, Mobile Heal h, mHeal h, Elec onic heal h,
and eheal h
PubMed, Scopus, Embase, Web o Science,
and Science Di ec
142
(Monaghesh and Hajizadeh, 2020) concluded ha he use
o eleheal h imp o es he p o ision o heal hca e especially
du ing he pandemic. I allows pa ien s and heal hca e wo ke s
who a e sel -isola ing o educe he isk o COVID-19 in ec ion,
mo bidi y and mo ali y du ing he pandemic. By using
elecommunica ions ools o iaging ( ideocon e ence, phone
call, e c…), assessing and ca ing o pa ien s, he numbe o
pa ien s who ecei e ace- o- ace heal hca e se ices can be
educed. Teleheal h also can also p o ide men al online heal h
se ices o isola ed pa ien s o help hem cope wi h he s ess,
dep ession and anxie y o lockdown. Alle gy and immunology
se ices can also be ende ed a a dis ance. The e a e many
easy- o-se -up li e ideo con e encing se ices ha a e use ul
o people who wan consul a ion on COVID-19, medica ion
checks, iage when elephone is no enough and pa ien s ha
a e pa icula ly anxious abou isi ing he doc o . Ano he
g oup ha could po en ially bene i om hese echnologies
a e he elde ly. Howe e , (Monaghesh and Hajizadeh, 2020)
highligh s ha he e a e ba ie s o la ge scale use o eleheal h
ha equi e u he in es iga ion namely he changes in billing
and coo dina ion o se ices.
Finally, (Bokolo An hony Jn ., 2020) showed ha
elemedicine is no hing new and ha his echnology is now
widely a ailable, low-cos and accep ed by heal hca e wo ke s
and pa ien s. In he con ex o he COVID-19 pandemic, he use
o elemedicine became a necessi y and exploded. The po en ial
o his echnology is ha i allows o examine a pa ien ’s heal h,
i ually educa e pa ien s and s o e heal h in o ma ion o
pa ien s ha is use ul o u u e examina ion. (Bokolo An hony
Jn ., 2020) ci es he US, China and Aus alia as success s o ies
in using elemedicine and ocuses on he guide- lines o he
use o elemedicine and i ual applica ions. P i acy and
consen laws a y widely among coun ies. As a esul ,
physicians should unde s and he p i acy and con iden iali y
policies ha should be ollowed du ing online consul a ions.
Physicians should d ess p o essionally, make eye con ac wi h
he pa ien s, be wa m and iendly and ensu e p ope ligh ing
in he examina ion posi ions. In addi ion, physicians should
con i m ha he pa ien has wo king mic ophones/cama a,
ha elemedicine a e co e ed by he pa ien s’ heal h insu ance
and , i necessa y, help hem use he i ual pla o m. To ensu e
p i acy, he i ual consul a ion should be in a quie place wi h
a s ong in e ne connec ion. Howe e , he adop ion o
elemedicine is a dis up i e p ocess ha s ill has many ba ie s
ela ed o he lack o in as uc u e, inadequa e unds and
inexpe ience. Ano he conce n ela es o pa ien p i acy policies.
De eloping coun ies (like hose o La in Ame ica) may also no
be able o ully adop elemedical se ices in emo e and u al
a eas whe e access o he In e ne is limi ed and e ec i e
elemedicine egula ion is lacking. Ano he challenge is educing
he inancial bu den o accessing eleheal h du ing heal h c isis
especially o low-income use s. Imp o ing he quali y o
in e ne access is also c ucial as slow in e ne may hinde he use
o ideocon e encing.
METHODOLOGY
We conduc ed a sys ema ic li e a u e e iew ollowing he
P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-
Analysis (PRISMA) amewo k o (Mohe e al., 2014). PRISMA
is an e idence-based minimum se o i ems o epo ing in
sys ema ic e iews and me a-analyses.
We sea ched o a icles in July o 2021 in i e da abases
(SCOPUS, Js o , Eme ald, SciELO, Science Di ec , IEEE) using he
ollowing e ms: ("Telemedicine" OR "Teleca e" OR "eHeal h")
AND ("COVID-19" OR "Co ona i us") AND ("Accep ance" OR
"Adop ion") AND DOCTYPE (a ) AND PUBYEAR>2019. In
addi ion, o ob ain mo e a icles w i en in Ibe o-Ame ica we
also used he ollowing sea ch e ms: ("Telemedicina" OR
"Telessáude" OR "eHeal h" OR "Telesalud") AND ("COVID-19"
OR "Co ona i us") AND DOCTYPE (a ) AND PUBYEAR>2019.
We excluded duplica es, hesis, disse a ions, monog aphies,
books and o he non- pee e iewed a icles. Likewise, we only
included a icles published a e 2019, w i en in Po uguese,
English and Spanish ha ocus on elemedicine. Ini ially, 1826
a icles we e ound. Endno e, a bibliog aphic-managemen
so wa e, was used o compile and manage he da abases. Each
ci a ion included he abs ac , keywo ds and he ull ex . A e
using Endno e o exclude he duplica es (231 a icles), wo
e iewe s sc eened he i les and abs ac s o 1595 a icles using
Rayyan QCRI. All disc epancies we e esol ed by consensus
be ween esea che s. Only 122 a icles me all he c i e ia o
inclusion and we e expo ed o a RIS. ile con aining he inal
sample ha was made up o po en ially ele an s udies wi h
hei ull ex s. A icles wi hou he ull ex and all pape s whose
ull ex did no ocus on elemedicine in he egion o Ibe o-
Ame ica we e excluded. Finally, a e e iewing he ull ex s,
106 a icles we e selec ed o a e iew and analysis (Figu e 1).
Pin o A. e al / J INFORM SYSTEMS ENG, 8(1), 19138 3 / 6
We impo ed he RIS. ile con aining his inal sample o 106
a icles o VOSViewe o isualize and c ea e maps o he main
keywo ds and au ho . Au oma ic coding was used o ob ain a
dend og am ha allows us o iden i y he mos used e ms.
Finally, we also analyzed he ci a ions o iden i y he mos
ele an au ho s and jou nals, as well as coun ies in Ibe o-
Ame ica whe e mos esea ch has been conduc ed.
DISCUSSION OF RESULTS
Resea ch Keywo ds, Themes and Sub hemes
In Figu e 2, we can see a co-occu ence analysis o he
keywo ds made using VOS iewe . O he 466 keywo ds
de ec ed, only 27 mee he minimum h eshold o 4 and all o
hem we e selec ed. 5 dis inc clus e s can be iden i ied in ed (12
i ems), g een (8 i ems), blue (5 i ems), yellow (1 i em) and pu ple
(1 i em). The 3 nodes wi h he g ea es o al link s eng h we e
elemedicine (190), elemedicina (164) and co id- 19 (158).
NVIVO12 was used o make a dend og am ha shows in he
ele ance o each o he keywo ds (Figu e 3). The 3 mos
men ioned hemes we e heal h (577 men ions), ca e (416) and
pa ien (310). Telemedicine con o e sial subjec , we ca ied ou
a sen imen analysis o see i he au ho s ha e a posi i e o
nega i e ou look on his heme. O e all, he au ho s main ain a
mos ly neu al one as one could expec om a scien i ic
publica ion (Figu e 4). Howe e , he e a e mo e nega i e
e e ences (3998) han posi i e ones (2307).
Figu e 1. PRISMA Flow diag am
Figu e 2. Ne wo k isualiza ion o main keywo ds using VOSViewe 1
1 Analysis conduc ed based on bibliog aphic da a om a RIS ile wi h he selec ed e e ences o analysis (n=106). Full coun ing was used and a
minimum h eshold o 4 occu ences pe keywo d was se .
Pin o A. e al / J INFORM SYSTEMS ENG, 8(1), 19138
4 / 6
Resea ch Me hodologies
In e ms o me hodologies, quali a i e s udies make up
o e 55% o he inal sample. S udies ha used a mixed and
quan i a i e me hodologies make up 23% and 20%
espec i ely. In quali a i e s udies, he mos common ypes o
a icles a e li e a u e e iews (14 a icles) and case s udy
analysis. Many au ho s sough o e iew he li e a u e on he
use o elemedicine in managing a speci ic disease like
Pa kinson (Mo eno López e al., 2020), pedia ic epilepsy
(Gómez e al., 2020) and ch onic obs uc i e pulmona y disease
(Ba bosa e al., 2020).
The mos s udied s akeholde s in elemedicine a e pa ien s
(28 a icles) ollowed by heal hca e wo ke s (13 a icles). The e
a e a ew s udies ha analyze his complex phenomenon he
poin o iew o bo h pa ien s and heal hca e wo ke s.
The mos widely used da a ga he ing ins umen s a e online
su eys/ques ionnai es (27 a icles). Besides su eys, o he da a
ga he ing ins umen s used we e in e iews and exis ing
da abases. In quan i a i e empi ical s udies, esea che s used
s a is ical so wa e o analyze he da a like SPSS. In mixed and
quan i a i e s udies, 19 a icles used jus desc ip i e s a is ics
(dis ibu ion, dispe sion and cen al endency) o p o ide basic
desc ip ions o da a om a sample. Howe e , in 16 a icles, he
au ho s use mo e ad anced in e en ial s a is ics me hods
(ANOVA, -squa e, Chi-Squa e). One a icle used S uc u al
Equa ion Modeling (SEM) echniques. By a , he mos common
limi a ion o hese s udies ela es o he size and
ep esen a i eness o he sample (especially when samples o
con enience a e used).
Figu e 3. Ne wo k isualiza ion o main keywo ds using VOSViewe 2
Figu e 4. Sen imen Analysis using NVi o123
2 Analysis conduc ed based on he ull ex s o he inal sample. NVi o sc eened e e y sen ence o all ex s. A ew Spanish e ms deemed edundan
we e excluded.
3 Analysis conduc ed based on he ull ex s o he inal sample. NVi o sc eened e e y sen ence o all ex s.
5 / 6
Pin o A. e al / J INFORM SYSTEMS ENG, 8(1), 19138
Rega ding unding, o e 78% o au ho s decla ed no
sou ces o unding. As o he a icles ha ecei ed unding, we
can classi y he unding o ganiza ions in o se e al g oups:
uni e si ies; public ins i u ions (a egional, na ional and EU
le els) and p i a e ins i u ions. In Ibe o-Ame ica, he public
sec o has been he mos ac i e in sponso ing esea ch on his
opic (17 ou o 21 a icles had, a leas , one public sponso ),
especially a na ional le el. Uni e si ies and he p i a e sec o
unded only 4 a icles ou o 21. I is also wo h s essing ha
some a icles we e unded by mo e han one ins i u ion.
Howe e , o he 21 a icles ha ecei ed unding, 81% ecei ed
unding om only one sponso and no a icle had mo e han 3
sponso s.
Au ho s, Jou nals and Coun ies
.
The mos ele an jou nal was Ac as De mo-Si iliog á icas
(4 a icles). No o he jou nal had mo e han 2 a icles. We only
included s udies ca ied ou in La in Ame ica o o m a g oup
o na ions ha a e cul u ally and geog aphically close, ha e
simila le els o de elopmen and we e hi by he pandemic a
he same ime. We also included Po ugal and Spain due o
hei cul u al p oximi y o La in Ame ica. The coun ies in
Ibe o- Ame ica wi h he mos a icles we e Spain (42 a icles),
B azil (28) and Colombia (8). In e ms o languages, e en hough
he esea ch was conduc ed by na i e Po uguese o Spanish
speaking au ho s om Ibe o-Ame ica, he mos widely used
language e- mains English (ci ca 66% o a icles in he inal
sample had a e sion in English), ollowed by Spanish (ci ca
50%) and Po uguese (ci ca 15%). I ´s also wo h no ing ha
many au ho s w o e se e al e sions o hei a icles in mo e
han one language: 23 we e w i en in English and Spanish, 10 in
English and Po uguese and 1 in Po uguese, Spanish and
Po uguese. A possible sou ce o bias de i es om he ac ha
NVi o so wa e was designed o analyze ex s in English.
Whene e possible we included he English e sion o he a icle,
howe e some a icles we e only in Po uguese o Spanish
meaning hey may no ha e been p ope ly analyzed. A co-
au ho ship analysis made using VOS iewe (Figu e 5). O he
665 au ho s, only 8 me he minimum h eshold o 2 a icles. In
he inal sample, no schola w o e mo e han 2 a icles. The low
le els o clus e ing shows ha co-au ho ship be ween au ho s on
his opic is ela i ely a e. The only was clus e composed o 6
Spanish au ho s (Bel ís, .; Ga cíaazo ín,d.; González- o ia,c.;
La o e, g.;López-b a o, a.; San os-lasoasa,s.) who published 2
a icles oge he and ha e he highes link o al link s eng h (10).
Figu e 5. Co-au ho ship analysis using VOSViewe 4
4 Analysis conduc ed based on bibliog aphic da a om a RIS ile wi h he selec ed e e ences o analysis (n=106). Full coun ing was used and a
minimum h eshold o 2 documen s pe au ho was se .

6 / 6
Pin o A. e al / J INFORM SYSTEMS ENG, 8(1), 19138
CONCLUSIONS
The aim o his sys ema ic e iew was o analyze he
exis ing li e a u e on elemedicine in Ibe o-Ame ica du ing he
COVID-19 pandemic. Mos schola s who published on his
opic, as one migh expec , ha e a backg ound in Medicine and
Heal h sciences. Howe e , schola s om o he ields like
Managemen , Psychology, Enginee ing and In o ma ion
Sys ems ha e also con ibu ed o esea ch on his complex
opic. Al hough se e al s udies ha e been ca ied ou in Ibe o-
Ame ica, esea ch in Ibe o-Ame ica on his opic lags behind
o he egions like Asia and No h Ame ica.
Telemedicine has bo h p os and cons and has eme ged as a
key al e na i e o manage heal h ca e sys ems du ing a
pandemic. In Ibe o-Ame ica, he e a e speci ic challenges
ela ed o he egions legal, cul u al and social con ex . Many o
he de eloping na ions o Ibe o-Ame ica should de elop a
na ional s a egy o expand he use o elemedicine and se ice
p o ide s should communica e he bene i s o hese
echnologies o consume .
Finally, i is impo an o discuss some o he limi a ions o
his e iew. Fi s ly, we could only include s udies om a
limi ed numbe o da abases (6). Secondly, we only included
s udies conduc ed in Ibe o-Ame ica, so cau ion needs o be
aken be o e gene alizing he indings o o he con ex s. Due o
ime cons ain s, he e iew p o ocol was no egis e ed.
Since he opic o esea ch is complex and e y ecen ,
u he esea ch is needed o s ay up o da e wi h he la es
de elopmen s o he pandemic. Fu he esea ch should also
ocus on he adop ion and use o elemedicine by ulne able
and unde se ed popula ions namely hose li ing in u al and
emo e loca ions, indigenous peoples, acial, sexual, and e hnic
mino i ies.
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