Online Consultation Research Has Shifted From Feasibility to System-Wide Implementation

A new bibliometric analysis of online consultation research, published in PLOS Digital Health, maps how the field has grown and changed over 35 years, showing a steady expansion of publication output that accelerated significantly after 2018 and peaked sharply between 2019 and 2022, a period coinciding with the COVID-19 pandemic’s rapid push toward remote care.

The study, led by Jing Liu and colleagues, analyzed 2,426 English-language journal articles indexed in the Science Citation Index Expanded within the Web of Science Core Collection, covering the period from 1990 to 2025. Using VOSviewer and the bibliometrix package, the team mapped publication growth, international collaborations, keyword co-occurrence, and thematic evolution, with country-specific trajectories examined for the leading contributors. Countries were ranked using full counting, and joinpoint regression was applied to identify inflection points in annual publication output.

The findings show that the United States, England, China, Canada, Australia, and Germany were the main contributors and served as central hubs in international collaboration networks. Online consultation itself has become a mainstream element of digital health within telemedicine, with video, telephone, and secure messaging extensively used for clinical advice, assessments, and follow-ups. Yet adoption remains inconsistent, particularly in regions with limited infrastructure and workforce capacity, and key challenges include patient engagement, integration into clinical workflows, and the efficient allocation of resources.

The thematic focus of the literature shifted markedly over time. Early research centered on feasibility studies, while later work moved toward service management, quality and outcome evaluation, barriers to implementation, equity considerations, and post-pandemic integration into standard care pathways. In other words, the field has evolved from proof-of-concept studies to a system-wide focus on management, evaluation, and large-scale implementation.

Country-specific trends were also evident. The United States focused on telemedicine models and reimbursement mechanisms, England concentrated on primary care and general practice, and China experienced rapid growth in telehealth research after 2018. According to the authors, these variations reflect differences in health system organization, regulation, reimbursement policies, and digital readiness across countries.

Looking ahead, the analysis suggests that long-term reimbursement strategies, interoperable digital infrastructures, and equity-oriented service design may support the sustainable implementation of online consultation services. As a bibliometric study, the work describes patterns in the published literature rather than measuring clinical outcomes directly, and it is limited to English-language articles indexed in a single database. Nevertheless, it offers a structured overview of how research attention to online consultation has matured, and it points policymakers toward the institutional conditions that appear to shape whether remote consultation services can be integrated into routine care.

Subject of Research: Bibliometric analysis of global trends and thematic evolution in online consultation research with digital health technologies

Article Title: Global trends and thematic evolution in online consultation with digital health technologies: Implications for future implementation and policy development

Article References: Liu, J., Gong, X., Yang, T., Xu, R., Tan, L., & Ye, H. (2026). Global trends and thematic evolution in online consultation with digital health technologies: Implications for future implementation and policy development. PLOS Digital Health, 5(10), e0001779. https://doi.org/10.1371/journal.pdig.0001779

Image Credits: AI Generated

DOI: 10.1371/journal.pdig.0001779

Keywords: online consultation, telemedicine, digital health, bibliometric analysis, Web of Science, COVID-19, health policy, reimbursement, health equity, international collaboration, telehealth, implementation science