diagnostic or therapeutic modality. With few exceptions, clinical studies … are descriptive rather than analytic [Perednia and Allen, 1995, p. 486].

There is little research demonstrating the effects and effectiveness of telemedicine. … Some commentators assert that it is effective across the board, whereas others are less sanguine. … It is clear that lingering questions will be answered only by well-designed and carefully conducted research [Grigsby, 1995a, p. 20].

To date, the appeal of telemedicine remains largely intuitive and based mostly on logical speculation and anecdotal evidence [Bashshur et al., 1994, p. 9].

With telemedicine there's sometimes more furor than fact [Wood, quoted in Scott, 1994, p. 35].

The paucity of evaluation research and results for telemedicine applications and programs was the primary stimulus for this study. It also is a factor in the reluctance of third party payers, including Medicare, to extend coverage and set payment rates for telemedicine technologies. Health plans and institutions that receive capitated or per case payments likewise want evidence that investments in telemedicine make sense.

Evaluation Efforts In Telemedicine

Recognizing the limited evaluative base for telemedicine applications, a number of government and private organizations have moved to support improved evaluation strategies and frameworks, to fund evaluation research, or to require demonstration project grantees to conduct their own internal evaluations and participate in related activities. These organizations include the National Library of Medicine, the Health Care Financing Administration, the Agency for Health Care Policy and Research, and the Office of Rural Health Policy in the U.S. Department of Health and Human Services; the National Telecommunications and Information Administration and the National Institute of Standards and Technology in the Department of Commerce; the Department of Veterans Affairs; and various Department of Defense units under the lead of the Surgeon General of the Army. Many federal agencies are, however, facing budget cuts. The burden of supporting telemedicine research may, as a result, fall more heavily on the military and the veterans' health

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