outcomes for the least healthy or most vulnerable groups in a population (e.g., elderly individuals, teenage mothers). For example, a telemedicine application might target a high-risk group to test whether telemonitoring, on-line information services, and early intervention could reduce total medical costs compared to conventional care.

This chapter has described the origins of this project and presented principles and definitions on which the remaining chapters build. The rest of this report provides a broad context and framework for evaluations that would expand information for decisionmakers considering telemedicine.

The next four chapters provide context. Chapter 2 reviews the evolution of telemedicine and illustrates the range of current applications. Chapter 3 considers the technical and human infrastructure of telemedicine, and Chapter 4 discusses policy issues with an emphasis on professional licensure, malpractice, medical privacy, payment for services, and telecommunications law. Chapter 5 reviews telemedicine evaluation frameworks and selected evaluation projects identified by the committee. As noted earlier, the focus is on programs in the United States.

The committee sets forth basic principles of evaluation and proposes elements for telemedicine evaluation in Chapter 6. Chapter 7 is organized around the quality, access, and cost outcomes but also considers patient and provider acceptance of telemedicine. The report concludes in Chapter 8 with the committee's findings and recommendations.

One theme runs through this report. Although telemedicine involves a large and quite varied assortment of clinical practices, devices, and organizational arrangements, its applications should be subject conceptually to the same evaluation principles as apply (or should apply) to other technologies in health care.