funding, technical assistance, research, and telecommunications infrastructure development that supports an array of applications, in particular, distance education.

Public policies, thus, present a mixed picture of incentives and disincentives for telemedicine that those contemplating telemedicine programs have good reason to examine carefully. Evaluators likewise may reasonably consider whether policy-related variables should be factored into evaluation plans. They may, for example, want to

  • be alert for changes in a telemedicine program intended to achieve consistency with state or federal policies;
  • enlarge the array of benefits, risks, and costs to be assessed;
  • extend the search for possible determinants of telemedicine's acceptability, affordability, and even availability to clinicians, patients, and others; and
  • investigate a broader range of practitioner or patient concerns about specific policy issues (e.g., privacy and confidentiality) to assess how well issues are understood and how important they are.

As additional context for the evaluation framework presented later in this report, this chapter examines several key policy issues. The first two sections briefly review federal and state initiatives to promote telemedicine either directly or as part of more general efforts to encourage communications and information technologies. The next three sections discuss professional licensure, malpractice, and the privacy and confidentiality of personal medical information. The final two sections consider telemedicine payment policies (a topic that covers both public and private actions) and the regulation of medical devices. Because it was not part of its charge, the committee did not make recommendations about the policy issues discussed here.

National Communications And Information Infrastructure Policy

The most newsworthy recent federal action affecting telemedicine is the Telecommunications Bill of 1996, a broad and far-reaching reform of communications law that is expected to alter dramatically

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