The majority of telemedicine programs are in the earliest stages of usage. As asserted by Bashshur (1998), the absence of mechanisms for reimbursement and related funding for telemedicine programs will continue to constrain the maturation of such programs, in turn preventing appropriate evaluation.
The findings from the recent literature are broken into two broad categories:
- Iterated points of the IOM evaluation framework.
- Supplementary points of the IOM evaluation framework.
In general, little new information is offered by the recent literature. Most often, articles restate or echo the findings of the IOM framework. Given that the IOM framework is a comprehensive study, includes an extensive review of the literature, and was completed in 1995, this is not unexpected.
Several broad issues arose from the literature review that could add to the IOM framework, and which are incorporated into the present report. First, evaluations of telemedicine should take into account the maturity of the program being evaluated (e.g., pilot versus a "steady state" programs). Second, integrated into any evaluation should be a more substantial and specific cost-effectiveness analysis to adequately take into account the unique nature of telemedicine applications. Third, an appropriately rigorous methodology should be applied to the evaluative process to ensure that the data gathered are useful to the health care community and those that it serves, providing evidence-based findings that can be used to support coverage decisions as appropriate. Finally, a staged approach to evaluation, similar to that used for pharmaceuticals, is suggested. These four points are addressed in following sections.
Among the points arising in the recent literature that reinforce the IOM framework are: 1) the need for a sensitivity analysis to take into account potential changes in the applications, conditions of use or cost of a technology, and how these might affect outcomes or costs of interest, 2) the necessity of developing appropriate outcomes, and 3) the unique challenges to developing an evaluation of a telemedicine program. These points are addressed below.