the privacy and confidentiality of personal medical information has stimulated legislative reform proposals but no action to date.
Major challenges confront those evaluating clinical applications of telemedicine. These difficulties also characterize many other applications of advanced technologies, and, thus, they are not unique to telemedicine. Nonetheless, the combination of challenges is formidable. They include
In addition, several more general challenges may complicate evaluations of clinical telemedicine. One is the restructuring of the nation's health care delivery system, which has brought with it shifts in institutional missions and priorities related to patient care, education, and research. A second is the growth of investor-owned enterprises that are not much inclined to allocate resources for purposes such as clinical research that do not add to corporate profits. At the state and federal level, policymakers are cutting budgets and may be reluctant to shift even modest resources from the core activities of grant programs to support evaluations of their actual consequences.
Fortunately, a number of government and private organizations