Work initiated in the Department of Defense (DOD) has played an important role in the activities of the Joint Working Group.¹ Within the DOD, the Assistant Secretary of Defense for Health Affairs established the Telemedicine Testbed to promote and manage digital telecommunications technologies within the Military Health Services System. The Army Surgeon General and the Commander of the Army Medical Research and Materiel Command at Fort Detrick, Maryland, were designated to lead these efforts with the Medical Advanced Technology Management Office, which includes personnel from the three services, coordinating activities at the program level.²

Testbed results are intended primarily to inform military decisionmakers, but an important additional objective is to collaborate with and contribute information relevant to civilian decisionmakers (Zajtchuk, 1995; Chestertown Roundtable, 1995). For example, the Army convened a two-week session at Tripler Army Medical Center that focused on the construction of clinical indicators for evaluation. Tripler is the hub of a developing telemedicine system that is to cover military operations around the Pacific Rim and to involve other governmental and private organizations in improving access to care in more remote parts of the region.

As a relatively self-contained system, the military offers a number of attractions for evaluators compared to the civilian sector. These include a large, defined population; an integrated health care delivery and financing system; salaried, full-time personnel; freedom from state regulation; multiple sites for comparing care alternatives and providing data; well-developed research and development