that a thorough discussion of those that might be integral to a telemedicine evaluation would be both lengthy and partly out of date before it was even published. A recent "buyer's guide" issue of a telemedicine journal included nearly 50 pages of small-type tables listing product and service suppliers, products, and product specifications for video conferencing room systems, desktop video products, teleradiology products, and medical peripherals such as electronic stethoscopes, dental cameras, and video oto/ophthalmoscopes (Telemedicine Today, 1996). The service listing included telecommunications service providers, those offering telemedicine related services, and organizations providing other resources including telemedicine research and evaluation (see Table 3.1).

Overall, however, the health care sector has been described as relatively slow in adopting advanced communications and information systems. For example, a 1995 survey of 10 business sectors found health care respondents showing the lowest level of agreement that information networking was critical (35 percent compared to 48 percent for government and 71 percent for banking) and the lowest level of electronic information transfer (7 percent compared to 19 percent for government and 25 percent for business services) (NRC, 1996, p. 35). An earlier analysis of the growing use of telecommunications technologies likewise suggested that the health care sector has lagged somewhat behind other sectors of the economy in finding opportunities to substitute less expensive telecommunications for more costly capital, labor, and materials (Cronin et al., 1994).

Health care organizations are often only a small part of the market for various information and telecommunication technologies. Although technologies such as computed tomography and laser surgery were explicitly tailored to health care uses, other equipment and tools may not be designed with clinical uses and settings in mind—at least, initially. For example, expensive digital cameras produce the high resolution images needed for teledermatology, but some features, which were designed with newspaper and magazine photographers in mind, may be of marginal clinical value (Van Riper, 1996).

Furthermore, manufacturers may abandon technologies useful for some telemedicine applications because the total market is too limited to justify continued support of the product or because corporate realignments have shifted business priorities. For example, committee members heard military personnel express concern about the



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