Abstract
Business model and financial recovery issues dominate discussions about using telemedicine to improve chronic disease management. The technical issues are numerous, daunting and complex, but many can be addressed using the resources and infrastructure available in large, well-integrated clinical information systems. The cost-benefit balance will change when it becomes possible to use devices that are owned by patients for everyday use, rather than installing special-purpose devices for telemedicine. Technology and communications capabilities are driven mainly by market factors other than uses for health care. Provider-side telemedicine capabilities, specifically for upload, storage and display of home medical data, will improve as technology develops. How health-care providers will process the larger amount of data made available by telemedicine is a clinical issue, but it is likely that software will emerge to assist in this task. The alignment of financial incentives for health-care providers is a decisive factor in understanding why telemedicine has had substantial deployment within the US Veterans Hospital Administration system, and to some extent within prison health systems and the Kaiser Permanente Health Plan, but much less widely in other settings.
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