Rethinking telemedicine evaluation for a new technological era

Abstract

For over three decades, healthcare providers have used advanced telecommunications technology to extend medicine's reach into dispersed geographical locations. This technology-based healthcare delivery process is called telemedicine, or "medicine at a distance". Telemedicine enables electronic transmission of patient information between healthcare providers via a variety of modalities. Despite the promise of this new approach and significant expenditure of funds, few rigorous comparative evaluation studies of the impact of telemedicine on the cost, quality, and access to healthcare or patient/provider acceptability have been done. In a new, rapidly changing technological era, evaluation of telemedicine is especially crucial to ensure future success and efficient use of resources. Telemedicine evaluation investigates the impact of telecommunications technologies on healthcare delivery and provides evidence of their effectiveness. Past failures illuminate factors that can thwart the success of future studies. To improve research efforts, the Joint Working Group on Telemedicine (JWGT), charged with coordinating activities across Federal cabinet agencies, has developed a broad and useful evaluation framework for telemedicine to strengthen designs and promote comparable evaluations. Additionally, a number of government and private organisations have supported improved evaluation frameworks and strategies. The military in particular is showing promise in pioneering modern evaluation methodology. In this paper, the authors discuss past stumbling blocks, new strategies, and examples where evaluation methodology is being applied in a new technological era.