Telemedicine Cooperative Group described earlier (see earlier section on the Telemedicine Research Center).

For the series of early demonstration projects funded in the 1970s, the awkward equipment, feasibility oriented projects, small numbers of patients, and high cost per patient served discouraged a sustained program of systematic development and research in telemedicine and apparently contributed to the disappearance of most of these projects. In the late 1980s and 1990s, as the technological base advanced and became more practical to use and as support for outcomes research and clinical evaluations gathered momentum, demonstration projects blossomed once again. The committee's discussions with those now involved in telemedicine evaluations suggest that they continue to face problems of small numbers of cases. In addition, securing relevant and comparable evaluation sites can be difficult given special data collection requirements, differing organizational and professional priorities, and reimbursement limits.

The committee was encouraged by the increased attention to evaluation by government agencies, health care organizations, and researchers and by efforts to develop creative strategies for overcoming or compensating for difficulties in undertaking sound evaluations. This work provides an important starting point. Much, however, remains to be done to build evaluation into telemedicine programs and to see more well-designed and well-executed studies of specific applications carried to conclusion. The next chapter presents the committee's framework for such studies.