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and interpret them when convenient, thus offering more scheduling flexibility for those on both ends of the communications link. In addition to patient care, these varied technologies have a multiplicity of current and possible uses in professional education, research, public health, and administration. Such multiple uses potentially allow costs for expensive information and communications investments to be spread more broadly.
This report was prompted by the scarcity of careful evaluations of patient care applications of telemedicine. It presents a broad framework for evaluating clinical applications of telemedicine and argues for more systematic and rigorous assessments of their effects on health care quality, accessibility, costs, and acceptability compared to alternative services. For telemedicine, as for any health technology or service, such assessments are essential for several reasons. They can
guide policymakers considering whether to encourage telemedicine by stimulating infrastructure development, funding specific telemedicine programs, or reducing policy barriers;
provide clinicians and patients appropriate reassurance or caution about telemedicine applications;
inform health plan managers pondering whether clinical telemedicine is feasible, cost-effective, and acceptable to patients and clinicians; and
help those who have invested in telemedicine find ways to identify problems and improve programs.
Because telemedicine is actually a family of quite diverse technologies and applications and because important educational, research, public health, and administrative uses and benefits may be intertwined with patient care uses, the evaluation framework proposed here will have to be adapted to fit different applications and environments. It may also have to be modified to consider links to other clinical and nonclinical programs that share parts of the same technical and human infrastructure. Such modification and adaptations notwithstanding, at the heart of the evaluation framework is a body of principles and methods that form the foundation for health services research and evaluation research generally. This report attempts to relate those principles and methods to the special challenges