Assessment of Approaches to Evaluating Telemedicine. Introduction


Telemedicine is the use of electronic communication and information technologies to provide health care when distance separates the medical professional from the patient. It also includes educational and administrative uses of these technologies in support of health care, such as distance learning and administrative videoconferencing. -- Association of Telehealth Service Providers (2000)

Telemedicine is part of the expanding use of communications technology in health care, or "telehealth," being used in prevention, disease management, home health care, long-term care, emergency medicine, and other applications. The diversification of such applications and continued advances in communications technologies, including the Internet, are raising expectations for telemedicine. However, the considerable attention focused on the technological aspects of telemedicine during the last decade has been accompanied by a lack of validated or well-demonstrated approaches for evaluating telemedicine. Indeed, although the feasibility of various telemedicine applications have been tested for more than 30 years, reliable data on costs, effectiveness, and other impacts of telemedicine remain limited (Grigsby, Kaehny, et al. 1995). For program funding and policy making, there is increasing need to develop and adapt evaluative frameworks for telemedicine.

In the mid-1990s, the National Library of Medicine (NLM) recognized the limited number and rigor of telemedicine evaluations. The NLM requested that the Institute of Medicine (IOM) develop a broad framework for telemedicine evaluation. For the purposes of its report, the IOM defined telemedicine as the use of electronic information in communications technologies to provide and support health care when distance separates the participants. In 1996, based on the deliberations of a 15-member expert committee, the IOM released its report, Telemedicine: A Guide to Assessing Telecommunications in Health Care. The report was intended to encourage evaluations that would guide policymakers, reassure patients and clinicians, inform health policy managers, and help those who had invested in telemedicine to identify shortcomings in, and improve upon, their programs. The report presented a framework built upon five main evaluation elements: 1) quality of care and health outcomes, 2) access to care, 3) health care costs and cost-effectiveness, 4) patient perceptions, and 5) clinician perceptions (IOM 1996).

Since 1996, the field of telemedicine has continued to evolve and mature. Recently, the DHHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) contracted with The Lewin Group to assess current approaches to evaluating telemedicine. In particular, ASPE requested that Lewin extend or otherwise update the 1996 IOM framework for telemedicine evaluation as it applies to telemedical consultations. ASPE specified that the scope of this study be focused on telemedical consultations between physicians and patients. Other applications of telemedicine, such as professional and patient education, or the electronic transfer of medical information not involving consultation, are beyond the scope of this study.

The objective of this report, Assessment of Approaches to Evaluating Telemedicine, is to identify areas in which telemedicine evaluation is likely to be most useful in informing future policy and program decisions. Lewin's effort entailed integrating findings from a literature review, gathering information on evaluations of telemedicine activities funded by HHS, and conducting interviews with representatives of telemedicine programs and other experts in the field.

This report describes the study methods, summarizes the study findings, and addresses how future evaluations could provide the most useful information on telemedicine activities. Based on these analyses, Lewin offers a set of main findings for guiding the design of future evaluations of telemedicine programs.

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