reviews challenges in evaluating telemedicine. The chapter then presents the evaluation principles set forth by the committee and a summary of the committee's evaluation framework and related recommendations and conclusions.

The Technical, Human, And Policy Context for Telemedicine Evaluations

Telecommunications and information technologies are evolving to provide and support medical care at a distance. Some of these technologies involve incremental improvements in the way familiar tools, such as the telephone, are used; others, such as telesurgery, involve devices and procedures that are still experimental.

The committee found general consensus about technical, behavioral, and policy factors that contribute to the modest implementation and documented success to date of the more technologically advanced forms of telemedicine. On the technical side, those responsible for deploying, sustaining, and managing information and telecommunications systems and programs face an often confusing array of constantly changing hardware and software options, many of which are not tailored to health care users. Assessing the utility of advanced technologies can be difficult, particularly given the frequent need to consider options in combination and not just individually. New systems generally have to be patched together with existing or legacy systems that cannot be immediately replaced. Although many groups are working to develop hardware and software standards, it remains frustrating and difficult to put together systems in which the components operate predictably and smoothly together and function in different settings without extensive adaptation.

The limited adoption of telemedicine also appears to stem from a variety of human factors. Research on factors affecting the acceptance of telemedicine is sparse, but the committee heard considerable consensus about practical, socioeconomic, and system constraints related to

  • meager evidence for clinicians that an application will benefit them in their day-to-day practice;
  • inadequate assessment of practitioner and community needs by those promoting telemedicine;
  • practical difficulties in incorporating telemedicine into daily

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