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Assessment of Approaches to Evaluating Telemedicine. Endnotes
1 Our first question asked respondents to informally "rank" areas that they felt would benefit most from further evaluation. Given our small sample size (N=15) and the expressed sentiment that these areas are interwoven (and therefore difficult to rank), we are able only to make qualitative statements about respondents' responses. [Back to Text]
Assessment of Approaches to Evaluating Telemedicine. References
Ackerman, Michael. Personal interview. 3 May 2000.
Association of Telehealth Service Providers. October 2000. Telemedicine FAQ. Available at: http://www.atsp.org.
Bashshur RL. Rethinking the evaluation and priorities in telemedicine [editorial]. Telemed J. 1998; 4(1):1-4.
Crowe BL. Cost-effectiveness analysis of telemedicine. J Telemed Telec
Assessment of Approaches to Evaluating Telemedicine. Appendix D: Telemedicine Experts Interviewed
Thelma Armstrong - Eastern Montana Telemedicine Network
Susan Capalbo - Associate Professor, Dept. of Agricultural Economics, Montana State University, Trace Research Center
Catherine Finley - Health and Human Services Policy Analyst, Southern Governor's Association
Bill Grigsby, Ph.D . - Senior Research Associate, Telemedicine Resear
Assessment of Approaches to Evaluating Telemedicine. Appendix C: Site-Visit Interview Protocol
(This protocol was used as a general guide in conducting site visits to ensure that discussions covered a broad range of issues.)
On what area of evaluation do you think evaluators of telemedicine should be focusing? (Please rank in order of most to least important.)
Quality of care and health outcomes
Assessment of Approaches to Evaluating Telemedicine. C. Conclusions
Elements drawn from the recent literature, including those concurring with the IOM framework and those that may augment the IOM framework, provide an initial understanding of the current state of knowledge regarding evaluation of telemedicine. Based on the recent literature, the IOM framework may be augmented in the following ways. (These are inco
Assessment of Approaches to Evaluating Telemedicine. 2. Supplementary Points to the IOM Evaluation Framework
Several main issues were raised in the recent literature that supplement the IOM framework in important ways. These points are outlined below.
a) Pilot Versus "Steady State" Evaluation
Assessment of Approaches to Evaluating Telemedicine. 1. Iterated Points of the IOM Evaluation Framework
Much of the literature on evaluation of telemedicine written since the IOM report has concurred with or further elucidated the information provided in the 1995 framework. Broad categories raised in the recent literature that enhance the IOM framework include:
development of appropriate outcomes,
the necessity of a sensitivity analysis, and
Assessment of Approaches to Evaluating Telemedicine. B. Findings
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 bro
Assessment of Approaches to Evaluating Telemedicine. A. Literature search strategy
The literature review was conducted by a direct search of the MEDLINE database (citations of peer-reviewed journal literature), the primary bibliographic database maintained by the National Library of Medicine.
Assessment of Approaches to Evaluating Telemedicine. Appendix B: Relevant Literature Review Findings
A review of the current literature was conducted to update, as appropriate, the IOM evaluation framework. The goal of the literature review is to update the IOM study with any relevant information having arisen within the last three years, and second, to supplement any gaps that may have been identified.
Assessment of Approaches to Evaluating Telemedicine. E. Indian Health Service
The Indian Health Service (IHS) is funding 40-50 small telemedicine programs across the country. To date, the IHS has performed few formal evaluations. It performed a cost-benefit analysis on teleradiology, which included exclusively store-and-forward technology. The IHS also evaluated patient and clinician perceptions of a telepsychiatry program
Assessment of Approaches to Evaluating Telemedicine. D. National Library of Medicine
The National Library of Medicine (NLM) offers two programs to encourage the use and development of telecommunications infrastructure. The High Performance Computing and Communications Program funds Internet access for health professions engaged in education, research, clinical care, and administration. The second program supports projects that dev
Assessment of Approaches to Evaluating Telemedicine. C. Health Resources and Services Administration
The HRSA Office for the Advancement of Telehealth (OAT) promotes the use of modern telecommunications and information technologies to bring state-of-the-art health care and health information to every community, particularly medically underserved and isolated regions. OAT has worked to expand HRSA's evaluation activities and coordinate the develop
Assessment of Approaches to Evaluating Telemedicine. B. Health Care Financing Administration(now known as Centers for Medicare and Medicaid Services(CMS))
In October of 1996, HCFA(now known as CMS) initiated a demonstration project to allow reimbursement of teleconsulting services by Medicare beneficiaries at 57 Medicare-certified facilities. The objectives of this project are to assess the feasibility, acceptability, cost, quality, and access to services that could be made available through Medicar
Assessment of Approaches to Evaluating Telemedicine. A. Agency for Healthcare Research and Quality
AHRQ's Center for Information Technology conducts and supports studies of health information systems, computerized patient record systems, and medical decision analysis, including data standards, automated medical records, and decision support systems. As a participant in the national High Performance Computing and Communications (HPCC) Program, A
Assessment of Approaches to Evaluating Telemedicine. Appendix A: HHS Telemedicine Evalutions
Within HHS, the bulk of telemedicine initiatives support and funding is provided by four agencies: the Agency for Healthcare Research and Quality (AHRQ), Health Care Financing Administration(now known as Centers for Medicare and Medicaid Services(CMS)) (HCFA(now known as CMS)), Health Resources and Services Administration (HRSA), and National Inst
Assessment of Approaches to Evaluating Telemedicine. Main Findings
Much of the present study serves to confirm and reinforce the 1996 IOM evaluation framework. The recent literature and interviews with telemedicine providers and other telemedicine experts provided examples of, and otherwise helped to elucidate many of the points raised by that framework.
Assessment of Approaches to Evaluating Telemedicine. 6. Time Horizon
The time horizon of a study refers to the study duration or length of follow-up for data collection. The time horizon for a comparative evaluation should be long enough to capture the stream of relevant health and economic effects that are sufficient to detect any differences in these between the intervention and control groups. To not do so may y
Assessment of Approaches to Evaluating Telemedicine. 5. Randomization
In clinical trials or other comparative studies, randomization refers to the technique of assigning subjects (usually patients) to an experimental intervention (often a new treatment) group and a control groups based only on chance distribution. The purpose of randomization is to reduce the opportunity for selection bias when assigning patients to
