Excerpt

In response to the scarcity of sound evaluations, the National Library of Medicine (NLM) asked the Institute of Medicine (IOM) to develop a broad framework for evaluating clinical telemedicine. This report, developed by a 15-member committee of the IOM, presents that framework, which focuses on telemedicine's effects on the quality, accessibility, cost, and acceptability of health care. The objective is to encourage evaluations that will guide policymakers, reassure patients and clinicians, inform health plan managers, and help those who have invested in telemedicine to identify shortcomings and improve their programs. This report is aimed primarily at these policymakers, clinicians, patients, and managers, but it is also intended to provide context and support for researchers with an interest in evaluating information and communications technologies.

Contents

• Committee on Evaluating Clinical Applications of Telemedicine
• Acknowledgments
• Summary
  • Telemedicine Past And Present
  • Challenges In Evaluating Clinical Telemedicine
  • A Framework For Evaluation
  • Basic Evaluation Questions
  • Conclusion
  • Appendix Questions About The Quality, Accessibility, Cost, And Acceptability Of Telemedicine
• 1. Introduction and Background
  • Telemedicine In Context
  • The Demand For Evidence Of Effectiveness
  • Study Origins And Approach
  • Terms And Definitions
  • Structure Of The Report
• 2. Evolution and Current Applications of Telemedicine
  • Evolution Of Distance Communication
  • Development Of Telemedicine
  • Current Applications Of Telemedicine
  • Conclusion
• 3. The Technical and Human Context of Telemedicine
  • The Technical Infrastructure
  • Human Factors And The Acceptance Of Telemedicine
  • Conclusion
• 4. The Policy Context of Telemedicine
  • National Communications And Information Infrastructure Policy
  • State Programs And Initiatives
  • Professional Licensure And Distance Medicine
  • Malpractice Liability
  • Privacy, Confidentiality, And Security
  • Payment Policies For Telemedicine
  • Regulation Of Medical Devices
  • Conclusion
• 5. Past and Current Evaluations of Telemedicine
  • Evaluation Efforts In Telemedicine
  • Evaluation Frameworks
  • Examples Of Individual Research Strategies
  • Conclusion
• 6. A Framework for Planning and Improving Evaluations of Telemedicine
  • Planning For Evaluation
  • Elements Of An Evaluation
  • Evaluation And Continuous Improvement
  • Conclusion
  • Addendum: Experimental, Quasi-Experimental, And Nonexperimental Designs
• 7. Evaluating the Effects of Telemedicine on Quality, Access, and Cost
  • Evaluation Criteria And Questions
  • Quality Of Care
  • Evaluating Access
  • Evaluating Costs And Cost-Effectiveness Of Telemedicine
  • Patient And Clinician Perceptions
  • Desirable Attributes Of Evaluation Criteria
  • Conclusion
• 8. Findings and Recommendations
  • The Technical, Human, And Policy Context for Telemedicine Evaluations
  • Challenges And Progress In Evaluating Telemedicine
  • Framework For Evaluating Telemedicine
  • Conclusion
• References
• Appendixes
  • A Examples of Federal Telemedicine Grants
  • B Glossary and Abbreviations
  • C Committee Biographies

Support for this project was provided by the National Library of Medicine and the Health Care Financing Administration, U.S. Department of Health and Human Services, under Contract No. N01-OD-4-2139. Additional support for dissemination of the report was provided by GTE.

The views presented are those of the Institute of Medicine Committee on Evaluating Clinical Applications of Telemedicine and are not necessarily those of the funding organizations.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.